COVID persistente. Elementos básicos para el médico de atención primaria

•La COVID persistente es una presentación clínica prevalente entre las personas contagiadas por SARS-CoV-2 que provoca multitud de síntomas que pueden afectar a prácticamente todos los sistemas del cuerpo y que impactan en la funcionalidad de las personas afectadas. •La dificultad inicial en su reconocimiento y diagnóstico han provocado un infradiagnóstico y un déficit en la atención sanitaria a las personas afectadas. •Hasta el momento no se han aclarado cuáles son las causas que producen la persistencia de síntomas invalidantes en personas infectadas por SARS-CoV-2 transcurridos 3 meses de la infección aguda. •No existe ningún tratamiento que haya demostrado ser efectivo en la curación de la COVID persistente. •El abordaje de las personas afectadas por COVID persistente debe recaer en la atención primaria priorizando la atención integral, el acompañamiento y la investigación.

Infant morbidity and mortality attributable to prenatal smoking in Chile

OBJECTIVE

To estimate annual infant morbidity and mortality attributable to prenatal smoking in Chile during 2008-2012.

METHODS

Population-attributable fractions (PAFs) for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure (prenatal smoking relative to non-prenatal smoking). Prenatal smoking-attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during 2008-2012 by the corresponding PAF.

RESULTS

PAFs for 1) births ≤ 27 weeks; 2) births at 28-33 weeks; 3) births at 34-36 weeks; and 4) full-term low-birth-weight infants were 12.3%, 10.6%, 5.5%, and 27.4% respectively. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were 11.9% and 40.0% respectively. Annually, 2 054 cases of preterm-birth and full-term low-birth-weight (1 in 9 cases), 68 deaths caused by preterm-related causes (1 in 8 cases), and 26 deaths caused by sudden infant death syndrome (1 in 3 cases) were attributable to prenatal smoking.

CONCLUSIONS

In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high. Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations.

Guinea worm infection in northern Nigeria: reflections on a disease approaching eradication

Global eradication of the guinea worm (Dracunculus medinensis) is near, although perhaps delayed a little by the discovery of a transmission cycle in dogs. It is therefore an appropriate time to reflect on the severe impact of this infection on the life of the communities where it was endemic prior to the start of the global eradication programme in 1981. From 1971 to 1974, we conducted a series of unpublished studies on guinea worm in a group of villages in Katsina State, northern Nigeria, where the infection was highly endemic. These studies demonstrated the high rate of infection in affected communities, the frequent recurrence of the infection in some subjects and the long‐standing disability that remained in some infected individuals. Immunological studies showed a high level of immediate hypersensitivity to adult worm and larval antigens but a downregulation of Th1‐type T‐cell responses to worm antigens. Freeing communities such as those described in this article from the scourge of guinea worm infection for good will be an important public health triumph.

The impact of alcohol consumption on African people in 2012: an analysis of burden of disease

OBJECTIVES

To determine the impact of alcohol consumption on deaths and disability in Africa.

METHODS

We estimated alcohol exposure for 2012, and its impact on deaths and disability in Africa using estimates from the WHO Global Health Estimates for outcome data, and the WHO Global Status Report on Alcohol and Health 2014 for risk relations. We provide a scenario that includes the impact of alcohol on HIV/AIDS incidence, and qualitative predictions on future exposure and harm.

RESULTS

Overall, alcohol consumption has a large impact on burden of disease and mortality in African countries. Alcohol-attributable disease burden is more important when the impact of alcohol consumption on the incidence and course of HIV/AIDS is taken into account, with alcohol being responsible, in 2012, for 6.4% of all deaths and 4.7% of all DALYs lost in the African region. Alcohol exposure is expected to increase in the next years, and thus alcohol-attributable fractions.

CONCLUSIONS

The weight of new evidence, especially of alcohol's role in the incidence and course of HIV/AIDS, is particularly relevant to African countries and points to the need for a strong policy response to reduce the alcohol-related burden of disease on the continent.

Hospital morbidity due to paracoccidioidomycosis in Brazil (1998-2006)

OBJECTIVE

To analyse hospital morbidity records due to paracoccidioidomycosis in Brazil, including its nationwide distribution in time and space, as well as key epidemiological and sociodemographic characteristics.

METHODS

Descriptive analysis of hospital morbidity records due to paracoccidioidomycosis covering the period January 1998 to December 2006. Hospital records were obtained from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS).

RESULTS

There were 6732 hospitalisations (82% male) due to paracoccidioidomycosis in the period, representing 4.3 per 1.0 million inhabitants. Admissions due to this mycosis were recorded in 27% of the 5560 Brazilian municipalities, covering 35% of the country. Ten municipalities concentrated 52% of all admissions. The temporal distribution of admissions for paracoccidioidomycosis showed a slight increase. The geographical analysis showed two distinct patterns of the disease: (i) traditional areas of southern and south-eastern regions, covering 60% of admissions, and (ii) a second pattern in northern Brazil revealed a transverse band of higher concentration with about 27% of admissions, particularly along the southern border of the Amazon region.

CONCLUSION

This first nationwide analysis of hospitalisation due to paracoccidioidomycosis in Brazil shows that it is the most prevalent systemic mycosis in Brazil. Despite its importance, there are major deficits in its proper registry, diagnostics and treatment. The particular epidemiological and medical challenges of paracoccidioidomycosis will not be met while the disease continues to be perceived as an isolated infectious entity restricted to a few faraway regions of the globe.

Health policy for sickle cell disease in Africa: experience from Tanzania on interventions to reduce under-five mortality

Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from noncommunicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10 313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD.

[Short-term time off work: its characteristics at a health centre from 2000-2002 inclusive]

OBJECTIVE

To describe short-term time off work procedures, its duration and the determining factors in an active population covered by health insurance at a health centre.

DESIGN

Descriptive and observational study of prevalence.

SETTING

Ribadeo Health Centre, Lugo, Spain.

PARTICIPANTS

All sickness certificates issued in 2000-2002 were included (n=1714).

MAIN MEASUREMENTS

The age and sex of each patient, amount of time off, place of residence (rural/urban), job (according to CNAE-93), type of social security cover, and cause of illness (according to CIE-9) were all recorded.

RESULTS

The short-term time off rate ran at 14.79 per 100 persons a year. Mean age was 40.13 (SD, 12.08); 936 (54.6%) were male. 85.7% of time-off periods were due to chronic illness, 12.2% to accidents not at work and 2.1% to accidents at work. Main associated pathologies were bone and muscular problems (25.7%), respiratory system problems (16.4%), and traumatisms (16.2%). All episodes accounted for the loss of 114,355 working days. Mean days lost per worker were 99.79 (SD, 136.37). Mean days lost per episode were 66.72 (SD, 98.79). Multivariate analysis showed that longer episodes were associated with older patients, women and the self-employed or workers at home. The longest periods off work were caused by cancer and mental disorders.

CONCLUSIONS

Age, sex, job, and pathology are variables related to short-term time off work.

[Delivery of care pressure, frequency of attendance and pediatric morbidity at a health center. Age and seasonal variations]

OBJECTIVE

To inform on the demand for primary care paediatric services, with a view to improving health care delivery.

DESIGN

Observational retrospective study.

SETTING

Estella Health Centre (Navarra).

PATIENTS

All patients attended during 1999 at one of the two paediatric clinics at the health centre. They were divided by ages into breast-feeders (0-12 months), pre-school (1-5 years old), primary school (6-9) and adolescents (10-14).

MEASUREMENTS

The date, sex, age, type of consultation (on demand/scheduled) and health problem (CIPSAP-2) of the 6611 consultations were recorded. Frequency of visits, care pressure and seasonal distribution, related to age and type of consultation, were calculated.

RESULTS

There were 4600 on-demand consultations (69.6%) and 2011 scheduled ones (30.4%). Total frequency of attendance was 5.46, which was greater in on-demand pre-school children (6.4) and scheduled breast-feeders (13.3). Overall patient pressure was 28.2, though less (p < 0.05) in the summer months. The most common health problems in on-demand consultations were respiratory illnesses (52.8%), infectious diseases (7.5%), neuro-sensory problems (6.8%), accidents (6.0%) and digestive problems (4.7%). There was negative correlation (p < 0.05) between age and the prevalence of respiratory diseases, whereas age was directly proportional (p < 0.05) to the prevalence of accidents and locomotive illnesses. Respiratory and infectious diseases were more common (p < 0.05) in the autumn and winter months.

CONCLUSIONS

Paediatrics at a health centre suffers patient overload, with acute illnesses of the respiratory apparatus, and to a lesser extent infectious diseases, the main causes of consultation. Health check-ups are becoming steadily more important. There needs to be better coordination between PC teams in order to unify diagnostic and therapeutic criteria, for the more thorough non-hospital paediatrics becomes, the greater its effect on improving child health quality.

[Hypertension in the elderly and health global results with different pharmacological therapies]

OBJECTIVES

To describe the benefits of treatment for hypertension in the elderly, the most efficient drugs, those most widely used in clinical practice to reduce morbi-mortality taken from the literature.

DESIGN

Systematic review.

PARTICIPANTS

Review study in Medline and the Cochrane Collaboration database. The antihypertensive pharmacological treatment is described (diuretics high and low dosage, calcium channel blockers, ACE inhibitor, and beta-blockers) administered to elderly people and their outcomes in morbi-mortality.

MEASUREMENTS AND MAIN RESULTS

Reduction in coronary and cerebral morbidity and general, cardiovascular and cerebrovascular mortality.

RESULTS

There is evidence to suggest that treatment for hypertension is helpful in the elderly, although efficiency is doubtful in patients over 80 years old. For persons aged over 65 general mortality is RR = 0.84 (0.75-0.94) and coronary morbidity RR = 0.80 (0.70-0.92). For persons aged over 80 general mortality is RR = 1 (0.86-1.17) and cardiovascular mortality is RR = 0.94 (0.75-1.18). Not all pharmacological groups produce the same results in mortality and morbidity. Diuretics (low dosage) offer better results than the remaining treatments reducing cardiovascular mortality as well cerebrovascular morbidity.

CONCLUSIONS

Treatment with drugs in hypertense elderly people is beneficial in terms of mortality and morbidity. Treatment with low dose diuretics, with or without potassium savers, is the elective treatment for hypertension in elderly patients.