Vitamin D levels among anesthesiologists and other physiciansBackground: Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim: To investigate the determinants of vitamin D levels in physicians. Material and Methods: Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results: We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p < 0.01). Conclusions: Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor.
Background: The first case of COVID-19 was reported in Chile on March 3, 2020. Public and private hospitals were managed in a centralized manner. On May 30, Chile had 99,668 cases, 1054 deaths, 1383 ICU patients, 1174 patients on invasive mechanical ventilation (IMV), and 51 patients on non-invasive ventilation (NIMV). Research question: What are the variables associated with condition at discharge?Method: We performed a retrospective cohort study of 529 patients with a positive RT-PCR for SARS CoV-2who were consecutively discharged between March 14 and June 4, 2020, at Clínica Dávila, Santiago. Patients were analyzed according to laboratory variables on admission, Quality-Adjusted Life Year (QALY) score, health insurance, and type of respiratory support. Condition at discharge was survivor, non-survivor, or transfer to another center. Differences were evaluated by Chi-square test, Student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge.Results: Median (interquartile range, IQR) age was 49 (37–62) years, and the median (IQR) stay in the hospital was 6 (3–10) days. A total of 352 patients (66.5%) had respiratory symptoms, 177 (33.4%) had other symptoms or diagnoses on admission, and 116 required ventilatory support; 448 (84.7%) were survivors, 54 (10.2%) were non-survivors, and 27 (5.1%) were transferred. The median ages of the survivors and non-survivors were 46 (36–59) and 75.5 (66–84), respectively.Having state health insurance increased the risk of death by 2.8-fold (OR, 2.825; 95% CI: 1.383–5.772; P = 0.004). Multivariate analysis revealed the following predictive variables: age ≥ 60 years (OR, 15.3; 95% CI: 7.25–32.2; P = .001); PaO2/FiO2 on admission ≤ 200 vs > 200 (OR, 5,205; CI 95%: 1,942–13,94); high-sensitivity troponin, ≥ 15 vs <15 ng /L (OR, 5,163; 95% CI: 1.95–13,64; P = .001); and QALY ≤ 15 vs > 15 points (OR, 14,011; 95% CI: 4,826–40,679; P=.001).Interpretation: The variables analyzed and patient’s clinical evolution may allow assignment of ICU beds to patients with the greatest chance of survival, especially in countries or regions where this resource is limited.
Paradoxical reactions associated with midazolam conscious sedationBackground: Benzodiazepines are used for perioperative conscious sedation. However, its use may be associated with paradoxical reactions. The known risk factors for these reactions are age, alcohol and drug abuse and psychiatric disorders. Aim: To assess the incidence and impact of risk factors of paradoxical reactions to midazolam. Material and Methods: Cross sectional study of 218 patients aged 50 ± 16 years (51% women) scheduled for elective surgical procedures under regional anesthesia and midazolam sedation. The paradoxical reactions were classified according to their severity in three categories. Results: The incidence of paradoxical reactions to midazolam was 8.3% (95% confidence interval (CI) 5.0-12.7). All were mild and only 28% of the affected patients required pharmacological treatment, none of them flumazenil. A multivariable logistic regression model showed that the variables independently associated with a paradoxical reaction to midazolam were the use of psychoactive medications , p = 0.04, and the dose of midazolam ], p = 0.03. Conclusions: The incidence of paradoxical reactions to midazolam was 8,3% and all were mild. Their risk factors are the use of psychoactive medications and the use of higher doses of midazolam.
On June 04, 2020, Chile had 113,628 cases COVID-19, 1275 deaths, 1450 patients were on invasive mechanical ventilation (IMV). The objective was describing the characteristics on admission and their relationship with the condition at discharge of patients with positive real-time polymerase chain reaction test for SARS CoV-2 (RT-PCR) in a tertiary health center. Methods: Retrospective and observational cohort study of 529 consecutive patients with positive RT-PCR for SARS CoV-2, discharged between March 14 and June 4, 2020 from Clinica Davila, Santiago. Demographic data, laboratory tests, Quality Adjusted Life Years (QALY), medical insurance, ventilatory assistance, and discharge condition were collected. Differences were Cesar Maquilon Ortiz et al.: Clinical and Demographic Characteristics on Admission and Their Prognostic Value at Discharge in 529 Consecutive COVID-19 Patients in Santiago, Chile evaluated by chi-square test, student's t test, or Mann-Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge. Results: A total of 529 patients were included (median age, 49 years [interquartile range {IQR}, 37-62; range, 0-97 years]; 45% women). The most common comorbidities were hypertension (171, 32.3%) and diabetes mellitus (98, 18.5%), On admission 352 patients (66.5%) had respiratory symptoms and 177 (33.4%) had other symptoms or other diagnoses. The median (IQR) PaO 2 / FiO 2 on admission of survivors, non-survivors and transferred were 316 (261-360), 167 (80-268) and 212 (130-261) respectively. At discharge, 448 (84.7%) were survivors, 54 (10.2%) nonsurvivors, and 27 (5.1%) were transferred to other centers. Median age of survivors and non-survivors was 46 (36-59) and 75.5 (66-84) years. Of the 116 patients (21,9%) who received support ventilation, 67 were discharged alive (57.8%), 28 died (24%), and 21 (18%) were transferred to another hospital. The variables associated with risk of death were:
(HR: 2.10, 95% CI: 1.32;3,22), cancer (HR:2.10, 95% CI: 1.32; 3.22), requirement of transfusion (HR: 1.79, 95% CI: 1.13; 2.83) and an American Society of Anesthesiologists (ASA) Class III classification (HR: 1.95, IC95%: 1.21; 3.15 (Rev Med Chile 2013; 141: 34-40).
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