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Tabaquismo como factor de riesgo del infarto agudo al miocardio
Leal-Mateos,Manrique; Solano- Chinchilla,Teresita;
Acta Médica Costarricense , 2006,
Abstract: rationale: cigarrette smoking is the main, preventable cause of premature illness, disability and death worldwide. at present, is widely recognized as a risk factor for the development of cardiovascular disease. nevertheless, even though tobacco is generaly accepted as a direct cause of acute myocardial infarction, in our country, knowledge about its attributable fraction is limited. objective: the purpose of this study is to evaluate the impact of cigarrette smoking on acute myocardial infarction patients measuring its attributable fraction. with this study, our purpose is to estimate the proportion of patients who could prevent the development of an acute myocardial infarction if exposure to this risk factor was avoided. methods: a case-control study was done in the internal medicine and surgery wards at the san juan de dios hospital comprising the period between april the 1st and september the 23rd of 2005. a smoker was defined as any patient which had smoked, at least, 1 cigarrette a day during 1 year. according to their smoking habits, the patients were classified as: non smokers (never smoked), smokers (current smokers) and ex-smokers. the magnitude of the associations between the exposure and the risk of illness was measured by means of the 2:1 paired odds ratio in which we defined those not exposed as the non smokers. those who had not smoked for over 15 years were classified as non smokers (given the long-term benefits which quitting entails) and those who had not smoked for less than 15 years were classifed as smokers. to measure the impact of cigarrette smoking on acute myocardial infarction patients, we used the indicator called attributable fraction. for this purpose, we used the epitable feature a in epiinfo 6?. results: the 2:1, paired odds ratio showed a positive association between smoking and the development of acute myocardial of 2.58 (95% ci 1.17 to 5.70) the attributable fraction in those exposed was 64.7% (95% ci 14.6 to 82.5). conclusion: slig
Tabaquismo como factor de riesgo del infarto agudo al miocardio
Manrique Leal-Mateos,Teresita Solano- Chinchilla
Acta Médica Costarricense , 2006,
Abstract: Justificación: El tabaquismo es la principal causa de enfermedad, discapacidad y muerte prematura prevenible mundialmente; actualmente, es aceptado como un factor de riesgo para el desarrollo de enfermedades cardiovasculares. Sin embargo, aunque el tabaco es conocido como una causa directa de IAM, en el país es limitado el conocimiento de su fracción atribuible. Objetivo: Este estudio tiene como propósito evaluar el impacto que provoca el tabaquismo sobre los pacientes con IAM, por medio de su fracción atribuible. Así, pretende estimar la proporción de personas que podrían prevenir su desarrollo, si se evitara la exposición a este factor de riesgo. Métodos: Se realizó un estudio de casos y controles en los servicios de medicina interna y cirugía del Hospital San Juan de Dios, en el periodo comprendido entre el 1 de abril y el 23 de septiembre de 2005. Se definió como fumador aquel paciente que hubiera fumado al menos un cigarro por día, durante un a o. De acuerdo con el hábito de fumar, se clasificaron en: No fumadores (quienes nunca habían fumado), fumadores (quienes fumaran actualmente) y exfumadores. La magnitud de las asociaciones entre la exposición y el riesgo de la enfermedad se evaluó mediante la razón de probabilidades (Odds Ratio en inglés) para datos apareados 2:1, definiendo como no expuestos aquellos pacientes clasificados como no fumadores. Los exfumadores con más de 15 a os de haber abandonado el hábito fueron clasificados como no fumadores (dados los beneficios que representa esta situación a largo plazo) y aquellos con menos de 15 a os de haberlo abandonado, fumadores. Con el fin de medir el impacto del tabaquismo sobre los pacientes que padecen de infarto agudo al miocardio se utilizó el indicador de fracción atribuible. Para todo lo anterior se utilizó Epitable, del programa EpiInfo 6. Resultados: La Razón de Probabilidades para datos apareados 2:1 mostró una asociación positiva entre el fumado y del desarrollo de un IAM, de 2,58 (IC95% 1,17-5,70). La fracción atribuible en los expuestos fue del 64,7% (IC 95% 14,6-82,5). Discusión: Se puede concluir que un poco más de la mitad los casos que se diagnosticaron con IAM en el HSJD, durante el periodo de estudio obedecen a la exposición activa de los pacientes al tabaquismo. Rationale: Cigarrette smoking is the main, preventable cause of premature illness, disability and death worldwide. At present, is widely recognized as a risk factor for the development of cardiovascular disease. Nevertheless, even though tobacco is generaly accepted as a direct cause of acute myocardial infarction, in o
Características del control prenatal de pacientes adolescentes atendidas en la consulta de obstetricia Hospital ?Dr. Rafael ángel Calderón Guardia?, 2010
Giacomin-Carmiol,Loretta; Leal-Mateos,Manrique;
Acta Médica Costarricense , 2012,
Abstract: aim: to compare perinatal results of pregnant adolescents that attend the prenatal control consultation at hcg with those published by the clap for adolescent population in latin america. materials and methods: 360 medical records of pregnant patients under 18 years, that undertook prenatal control at the adolescents’ clinic of the department of obstetrics of the hcg in 2010, were studied. the variables included in the study were those related with prenatal care, childbirth and postpartum. hypothesis testing was used to compare the results obtained in this investigation with those reported by the clap. 1.96 was adopted as the critical value from z distribution (p <0.05). results: this study showed that maternal morbidity and mortality of adolescent patients that received attention in our hospital is lower than that reported by the clap. although there was a higher percentage of some diseases such as urinary tract infections or anemia in our population, this might be due to a better case detection system rather than to an increase in disease. with regard to the newborn, there were no significant differences with respect to the percentage of preterm births, low birth weight or very low birth weight. the fact that approximately 97% of patients had their labor at term or close to it (more than 34 weeks gestation) and having a neonatal intensive care unit could explain the low neonatal mortality present in our study’s adolescents. conclusions: maternal and neonatal morbidity and mortality in adolescent patients that received attention in our hospital is lower than that reported by clap for adolescent populations.
Mortalidad por cáncer en la persona adulta mayor de Costa Rica
Leal-Mateos,Manrique; Ortiz-Barboza,Adolfo;
Acta Médica Costarricense , 2005,
Abstract: objective: cancer mortality analysis in elderlys is still an important tool to identify associated risk factors. the goal of the present study is the analysis of mortality due to cancer in older adults during the year 2002 in costa rica. methods: this was a descriptive, cross-sectional study. the source of information was the database kept by the cpp-inec. it was made available to us by the reference centers of the same institutions. the variables studied were: age, sex and place of residence of each deceased person. besides, the anatomical location of the tumors was based on the international classification of diseases (i.c.d.-10). through a direct adjustment of rates, we analyzed the mortality by region. results: during the year 2002, 3,167 cancer deaths were registered in costa rica. of these, 1,960 (61.8%) happened in people older than age 65. 58.2% (n= 1,141) were among males and 41.8% (n=819) among females. prostate cancer showed the highest mortality rate. by calculating the province-adjusted mortality rates, the province of cartago showed the highest rates. discussion: 61.8% of all the deaths due to cancer in costa rica occurred in the elderly adult population. this result is important if we consider the cost which the attention of this type of patient represents for the health services. the risk of death due to cancer is considerably greater after 65 years of age. therefore, the reduction of mortality must be achieved by means of preventive programs of lower cost and which must be developed at younger ages.
Características del control prenatal y el parto de las mujeres inmigrantes atendidas en el Hospital "Dr. Rafael ángel Calderón Guardia"
Leal-Mateos,Manrique; Barboza-Retana,Jorge;
Acta Médica Costarricense , 2008,
Abstract: aim: to examine the characteristics of prenatal control and delivery in the immigrant population that gives birth at the "rafael angel calderon guardia hospital (hcg), costa rica. this study will compare the results obtained within the immigrant population with those of the native costa rican population and will determine the differences, if any, between the standard of prenatal care and delivery in the immigrant population and that of the native costa rican population. materials and methods: this study is a cross-sectional observational study. three hundred and sixty medical records were analyzed, patients that were treated at the hcg, but did not belong to the hospital?s attraction area or had an incomplete record were excluded. the information for the study was collected using a pre- coded information sheet similar to the one used by the country?s national health system. results: this study demonstrates that immigrant women account for 1 out of every 5 patients giving birth at the hcg. the majority of these immigrants are young, multiparous, nicaraguan women with adequate prenatal control. the study also shows that the morbidity in the immigrant population is similar to that of the costa rican population. it is also noteworthy to mention that half of the immigrant patients began their prenatal control after 13 weeks of gestation, and, had a less prenatal consults than the costa rican population. this finding does not seem to have any influence over delivery or neonatal outcomes in the immigrant population. conclusion: there are no significant medical differences between the immigrant population that gives birth at the hcg and the native costa rican population.
Sobrevida en pacientes con cáncer de cervix
Ortiz-Barboza,Adolfo; Leal-Mateos,Manrique;
Acta Médica Costarricense , 2005,
Abstract: objective: to estimate 5 year calculate the five-year cumulative survival probability of a patient cohort diagnosed with interine cervical cancer during 1999. methods: to analyse of the information, we used frequency distributions with absolute values as well as percentages, measures of central tendency as well as of variance. the relation ship between cualitative variables was done by means of a chi square statistical test. a p value less or equal to 0.05, was significant. the cumulative survival probability was done using the kaplan-meier method. the comparison between the survival times was done using a logarithmic range test. the level of significance was again fixed at less or equal to 0.05. results: a total of 778 cases were studied at the end of the study period, 91 patients had died. the 5 year, cumulative survival probability for the whole population was 88.3%. the patients in which carcinoma in situ was detected at the time of diagnosis, showed a cumulative survival probability of 98.8% while those with invasive carcinoma had a value of 68.3%. this difference was statistically significant. the cumulative survival probability for the patients diagnosed with squamous cell carcinoma was 89% while those with adenocarcinoma had a value of 80%. this difference did not fall within the range of statistical significance, though. conclusions: if we compare our results with similar investigations done elsewhere, we can see that our values are superior to those seen in countries with a level of development lower than that of costa rica and that, they are similar of those of developed countries. with the results obtained, we could as sume that the cumulative survival probabilities are greater in those patients in whom the diagnosis of cervical cancer is done at a young age; in addition, this may be related to the high proportion of carcinoma in situ cases diagnosed at this stage in life. when the prognosis for this illness is more favorable.
Análisis sobre el uso de exámenes preoperatorios en pacientes sometidas a cirugías programadas en el Servicio de Ginecología del Hospital "Dr. Rafael ángel Calderón Guardia", durante 2009
Leal-Mateos,Manrique; Madrigal-Solís,Juan B;
Acta Médica Costarricense , 2010,
Abstract: aim:to analyze the use of routine preoperative tests in patients undergoing elective gynecologic surgery at the rafael ángel calderón guardia hospital during 2009. methods: this is a cross-sectional observational study. two hundred seventy two medical records were analyzed of patients who underwent surgery between january 1st 2009 and june 3rd of 2009. the variables studied were: age, coexisting morbidity, amount and type of additional preoperative tests performed and amount and type of preoperative missing tests according to the 2002 guidelines of the american society of anaesthesiologists (asa). results: the mean of preoperative tests preformed for each patient was 4,3 (sd + 2,1). according to the asa guidelines, only 44,9% (ci: 95% 38,8-51,0) of the patients had all the preoperative test completed. in addition 55,1% (ci: 95% 49,0-61,2) of the patients missed at least 1 of the preoperative needed tests. the mean of the preoperative tests missing in this case was 1,7 (sd +1,1). on the other hand, 93% (ci: 95% 89,3-95,7) of the patients had undergone at least 1 unnecessary preoperative test according to their morbidity. the mean of this additional preoperative test was 2,5 (sd +1,6). nine point five percent of the total of unnecessary preoperative tests showed abnormal results. only 7,6% (ci: 95% 2,5-16,8) of the medical records of these patients showed some corrective action. three percent (ci: 95% 0,4-10,5) of the surgeries were cancelled for this reason. conclusion: this study showed the incorrect use of preoperative tests in the gynecology service of the calderón guardia hospital.
Prevalencia de bajo peso en recién nacidos atendidos en el Hospital San Rafael de Alajuela
Leal-Mateos,Manrique; Salazar-Solís,Ricardo;
Revista Costarricense de Ciencias Médicas , 2004,
Abstract: prematurity and low birth-weight considerably increase neonatal mortality. ln industrialized countries, these events are some of the greatest predictors of neonatal mortality. to analyze the prevalence of these phenomena in national hospitals is of great importance, not only to measure their occurrence but also to state possible hypotheses of causality which allow health -service planning with greater efficiency and the possibility of evaluating new public health needs. the aim of the study was to establish the prevalence of low birthweight in newborns attended to in the obstetrical service of the hospital san rafael de alajuela during the year 2003, as well as neonatal factors associated with this event. a descriptive, retrospective and cross-sectional investigation was done. the sampling frame was the number of births included in the statistical registry of the delivery room of the obstetrical service of the san rafael hospital in alajuela. the sampling method was randomized and systematic. the maternal variables collected were: age, civil status and number of pregnancies. the neonatal variables studied were: sex, birthweight and gestational age. the sample analyzed included 396 live births. the average birthweight was 3, 198 grams (95% confidence interval between 3151.8 grams to 3244.2 grams.) 6.6% showed a birthweight lower than 2500 grams. the prevalence of low birthwieght in san rafael hospital of alajuela was 6.6%, which is lower than the percentage registered for latin america and for costa rica
Mortalidad por cáncer en la persona adulta mayor de Costa Rica
Manrique Leal-Mateos,Adolfo Ortiz-Barboza
Acta Médica Costarricense , 2005,
Abstract: Justificación y objetivo: El análisis de la mortalidad por cáncer en el adulto mayor continúa siendo una herramienta importante para identificar los factores de riesgo asociados. El presente estudio tiene como finalidad analizar la mortalidad por cáncer en las personas adultas mayores del país durante el a o 2002. Métodos: Se realizó un estudio descriptivo de corte transversal. La fuente de información utilizada fue la base de datos del CCP-INEC, facilitada por los centros de documentación e información de estas mismas instituciones. Las variables estudiadas fueron: edad, sexo y lugar de residencia de cada persona fallecida. Además, se registró la localización anatómica de los tumores con base en la clasificación internacional de enfermedades (CIE-10). Mediante el ajuste directo de tasas de analizó la mortalidad por provincia. Resultados: Durante el a o 2002, se registraron 3 167 muertes por cáncer en el país. De estas, 1 960 (61,8%) ocurrieron en personas mayores de 65 a os. El 58,2% (n = 1141) afectaron al sexo masculino. El cáncer de próstata presentó la tasa más alta de mortalidad. Al calcular las tasas de mortalidad ajustada para cada provincia, se observó que Cartago presentó la tasa más alta. Discusión: El 61, 8% del total de muertes por cáncer en el país ocurren en la población adulta mayor. Este resultado resulta importante si consideramos el costo que representa para los servicios de salud la atención de este tipo de pacientes. El riesgo de fallecer por cáncer es considerablemente superior después de los 65 a os. Por tanto, la disminución de la mortalidad debe realizarse por medio de programas preventivos de menor costo y que se desarrollen en edades tempranas. Objective: Cancer mortality analysis in elderlys is still an important tool to identify associated risk factors. The goal of the present study is the analysis of mortality due to cancer in older adults during the year 2002 in Costa Rica. Methods: This was a descriptive, cross-sectional study. The source of information was the database kept by the CPP-INEC. It was made available to us by the reference centers of the same institutions. The variables studied were: age, sex and place of residence of each deceased person. Besides, the anatomical location of the tumors was based on the International Classification of Diseases (I.C.D.-10). Through a direct adjustment of rates, we analyzed the mortality by region. Results: During the year 2002, 3,167 cancer deaths were registered in Costa Rica. Of these, 1,960 (61.8%) happened in people older than age 65. 58.2% (n= 1,141) were among males and 4
Sobrevida en pacientes con cáncer de cervix
Adolfo Ortiz-Barboza,Manrique Leal-Mateos
Acta Médica Costarricense , 2005,
Abstract: Objetivo: Estimar la probabilidad acumulada de sobrevida a cinco a os, de una cohorte de pacientes diagnosticadas con cáncer de cervix durante 1999. Metodología: Para el análisis de la información se utilizaron distribuciones de frecuencia con valores absolutos y porcentuales, medidas de tendencia central y de dispersión. La relación entre variables cualitativas se efectuó mediante la prueba estadística de Chi cuadrado (X2). El nivel de significancia se fijó en p < 0.05. La probabilidad acumulada de sobrevida fue realizada mediante el método de Kaplan-Meier. La comparación entre los tiempos de sobrevida se realizó mediante el test de rangos logaritrnicoso El nivel de significancia fue fijado en p < 0,05. Resultados: Se analizaron 778 casos al final del periodo de estudio fallecieron 91 pacientes. La probabilidad acumulada de sobrevida a los cinco a os para toda la población fue del 88,3%. Las pacientes a las cuales se les detectó carcinoma in situ al momento del diagnóstico, presentaron una probabilidad acumulada de sobrevida de 98,8%, mientras que a aquellas a quienes se les detectó un carcinoma invasor, fue del 68,3%. Esta diferencia fue estadísticamente significativa. La probabilidad acumulada de sobrevida para las pacientes diagnosticadas con carcinoma de células escamosas fue de un 89%, mientras que para aquellas diagnosticadas con adenocarcinoma fue de un 80%. Esta diferencia no fue estadísticamente significativa. Conclusiones: Los resultados obtenidos muestran valores superiores a los determinados en otros países con un nivel de desarrollo inferior al nuestro, y similares a los encontrados en naciones desarrolladas. Con los resultados obtenidos, se podría suponer que las probabilidades acumuladas de sobrevida son mayores en aquellas pacientes a quienes se les realiza el diagnóstico de cáncer de cervix en edades tempranas, y que esto puede relacionarse con la alta proporción de carcinomas in situ diagnosticados en esta etapa de la vida y cuyo pronóstico es más favorable. Objective: To estimate 5 year calculate the five-year cumulative survival probability of a patient cohort diagnosed with interine cervical cancer during 1999. Methods: To analyse of the information, we used frequency distributions with absolute values as well as percentages, measures of central tendency as well as of variance. The relation ship between cualitative variables was done by means of a chi square statistical test. A p value less or equal to 0.05, was significant. The cumulative survival probability was done using the Kaplan-Meier method. The comparison between the surviv
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