Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Abstract Background: Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement. Objective: To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection. Methods: This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level. Results: This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4-24.5. Conclusions: Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.

Síndromes asociados a intoxicación por organofosforados: abordaje médico y fisioterapéutico en cuidado crítico / Syndromes Associated with Organophosphate Poisoning: Medical and Physiotherapy Approach in Critical Care / Síndromes associados a intoxicação por organofosforados: abordagem médica e fisioterapêutica em cuidado crítico

Resumen Introducción: El artículo reporta un caso clínico de intento suicida de un paciente con síndrome intermedio a causa de intoxicación por organofosforados. Para ello se analizó la historia clínica, los exámenes complementarlos y el estudio electromiográflco, y se realizó revisión no sistemática de la literatura. Presentación del caso: Se describe un caso diagnosticado en la unidad de cuidado intensivo, el cual presentó trastornos neuromotores, requerimiento de soporte ventilatorio con destete difícil y extubación fallida, así como el tratamiento médico y fisioterapéutico instaurado. Dentro del manejo de la intoxicación por organo-fosforados se incluye la descontaminación del tóxico, administración de atropina y pralidoxima, diagnóstico oportuno del síndrome intermedio y la prescripción de ejercicio terapéutico. El paciente recibió manejo interdisciplinario, logrando liberación de su condición crítica, pero con persistencia de debilidad muscular proximal; sin embargo, con el ejercicio alcanzó recuperación funcional de sus actividades básicas cotidianas. Conclusión: El panorama mundial de las intoxicaciones por sustancias químicas muestra que son causa de morbilidad y discapacidad importante. Los organofosforados son los plaguicidas más frecuentemente involucrados. Los síntomas y signos clínicos de este tipo de intoxicaciones se clasifican en manifestaciones colinérgicas, el síndrome intermedio y la neuropatía retardada.

Abstract Introduction: The article reports a clinical case of a suicide attempt of a patient with intermediate syndrome due to organophosphate poisoning. Researchers analyzed the clinical history and the complementary examinations and carried out an electro-myographic study and a non-systematic review of the literature. Case presentation: A diagnosed case is described in the unit of intensive care, which presented neuro-motor disorders, required ventilator support with difficult weaning and unsuccessful extubation, as well as the established medical and physiotherapeutic treatment. The management of organophosphate poisoning includes the decontamination of the toxic, the administration of atropine and pralidoxime, the diagnosis of the intermediate syndrome, and the prescription of therapeutic exercise. The patient received interdisciplinary management, achieving liberation from his critical condition but with the persistence of proximal muscular weakness; however, with the exercise, he accomplished functional recovery for basic daily activities. Conclusion: The global outlook of chemical substances poisoning shows that they are a cause of morbidity and significant disability. The organophosphates are the pesticides most frequently involved. The symptoms and the clinical signs of this type of intoxication are classified into cholinergic manifestations, intermediate syndrome, and delayed neuropathy.

Resumo Introdução: O artigo reporta um caso clínico de tentativa suicida de um paciente com síndrome intermeio a causa de intoxicação por organofosforados. Para isto, analisara-se história clínica, os exames complementários e o estudo eletromiográfico, e se realizou revisão não sistemática da literatura. Apresentação do caso: Descreve-se um caso diagnosticado na unidade de cuidado intensivo, o qual apresentou transtornos neuromotores, requerimento de suporte ventilatório com desmame difícil e extubação falhada, tanto como o tratamento médico e fisioterapéutico instaurado. Dentro do manejo da intoxicação por organofosforados se inclui a descontaminação do tóxico, administração de atropina e pralidoxima, diagnóstico oportuno da síndrome intermeia e a prescrição de exercício terapêutico. O paciente recebeu manejo interdisciplinar, conseguindo liberação de sua condição crítica, mas com persisténcia de debilidade muscular proximal; no entanto, com o exercício alcançou recuperação funcional de suas atividades básicas cotidianas. Conclusão: O panorama mundial das intoxicações por substâncias químicas mostra que são causa de morbilidade e deficiência importante. Os organofosforados são os pesticidas mais frequentemente envolvidos. Os sintomas e signos clínicos deste tipo de intoxicações classificam-se em manifestações colinérgicas, a síndrome intermeia e a neuropatia retardada.

Effects of muscle energy technique for quadratus lumborum on respiratory muscle strength in patients with breast cancer / Efectos de la técnica de energía muscular del cuadrado lumbar sobre la fuerza muscular respiratoria en pacientes con cáncer de mama

Abstract Introduction: Breast cancer is a major cause of morbidity and mortality, leading to functional deficiencies in ventilation, muscle performance, balance and posture. Objective: To describe the effects of the muscle energy technique (MET) for quadratus lumborum on maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in patients with stage I and II breast cancer. Materials and methods: Quasi-experimental study with a pretest-posttest design conducted in 10 patients treated at a highly specialized healthcare center in Bogotá. Physical therapy assessment and three physiotherapy sessions with the MET to measure MIP and MEP were carried out before and after the intervention using a respiratory pressure meter. Results: The average MIP was 41% of the reference value at the beginning of the intervention, which increased to 69% at the end of the sessions. On the other hand, the initial average MEP was 33%, while the post-intervention average MEP was 51%. The average change rate for MIP was 68% and 57% for MEP. The Wilcoxon signed-rank test was performed, achieving a statistically significant difference (z=-2.807, p=0.005). Conclusion: Applying the MET on the quadratus lumborum muscle improves its performance and increases respiratory muscle strength.

Resumen Introducción. El cáncer de mama constituye una importante causa de morbimortalidad y genera deficiencias funcionales en la ventilación, el desempeño muscular, el balance y la postura. Objetivo. Describir los efectos de la técnica de energía muscular (TEM) del cuadrado lumbar sobre la presión inspiratoria (PIM) y espiratoria máxima (PEM) en pacientes con cáncer de mama en estadios I y II. Materiales y métodos. Estudio cuasiexperimental tipo pre-test/post-test realizado en 10 pacientes atendidas en una institución de salud de alta complejidad de Bogotá D.C., Colombia. Se realizó valoración fisioterapéutica y tres sesiones de fisioterapia con la TEM midiendo PIM y PEM antes y después de la intervención con medidor de fuerza respiratoria. Resultados. El promedio de la PIN al inicio de la intervención fue de 41% y al final de 69%, mientras que el de la PEM fue de 33% y 51%, respectivamente. La media de la proporción de cambio en la PIM fue de 68% y en la PEM de 57%. Se realizó la prueba estadística de signo-rango de Wilkoxon, logrando determinar una diferencia estadísticamente significativa (z=-2.807, p=0.005). Conclusión. La TEM mejora el desempeño del músculo cuadrado lumbar e incrementa la fuerza muscular respiratoria.

Factores estresores y síntomas somáticos del sistema musculoesquelético en estudiantes universitarios de Palmira / Stress-producing factors and somatic symptoms of the musculoskeletal systems of University Students of Palmira

Introducción: En el mundo uno de cada cuatro individuos sufre de algún problema grave de estrés y en las ciudades se estima que el 50 por ciento de las personas tienen algún problema de salud mental de este tipo. En este sentido, como factor epidemiológico se considera un aspecto de gravedad, ya que el estrés es un importante generador de diversas patologías. Objetivo: Identificar los factores estresores y síntomas somáticos del sistema musculoesquelético en estudiantes de básicas pertenecientes a diversos programas de una facultad de salud en una universidad de la ciudad de Palmira. Métodos: Se analizaron datos procedentes de tres fuentes: un cuestionario para identificar características sociodemográficas y académicas, la Escala de Síntomas Somáticos (síntomas musculoesqueléticos) y la Escala de Estresores Académicos, estos se aplicaron a muestra conformada por 185 participantes realizando análisis estadístico descriptivo e inferencial. Resultados: Las deficiencias metodológicas del profesorado, la intervención en público y los exámenes, fueron los factores estresores frecuentemente percibidos por los estudiantes; mientras que: los dolores de espalda, zona cervical y cabeza con sensación de tirantez, fueron los síntomas somáticos musculoesqueléticos de mayor periodicidad. Estos resultados sugieren una relación entre los factores estresores y la presencia de somatización como respuesta del cuerpo a situaciones consideradas estresores en el ámbito académico. Conclusiones: De acuerdo a los síntomas somáticos músculos esqueléticos se evidencia una variabilidad en la incidencia en la población a estudio, siendo los más recurrentes los dolores de cabeza con sensación tirantez o tensión, dolores de espalda y dolores en la nuca o zona cervical. Ahora bien, en cuanto a los factores estresores que les genera más percepción de angustia a los estudiantes son las deficiencias metodológicas del profesorado, la intervención en público y los exámenes. Sin embargo, hay otros factores con mediana percepción de angustia como la sobrecarga en el estudiante y la falta de control en rendimiento(AU)

Introduction: One out of every four individuals in the world suffers from a serious stress condition. 50 percent of people living in the cities are estimated to have some kind of mental health problem of this type. In this respect, as an epidemiological factor, stress is considered a serious element, since it is an important generator of various pathologies. Objective: To identify the stress-producing factors and somatic symptoms of the musculoskeletal system in basic students belonging to various programs of a health school at a university in the city of Palmira. Methods: We analyzed data from three sources: a questionnaire to identify sociodemographic and academic characteristics, the Somatic Symptoms Scale (musculoskeletal symptoms) and the Academic Stress Scale. These were applied to a sample consisting of 185 participants, performing descriptive and inferential statistical analysis. Results: The faculty methodological deficiencies, together with public intervention and the exams were the stressors frequently perceived by the students, while back pain, cervical area and head with feeling of tightness were the most frequent somatic musculoskeletal symptoms. These results suggest a relationship between stressors and the presence of somatization as a response of the body to situations considered stressful in the academic field. Conclusions: Regarding somatic and musculoskeletal symptoms, there is a variability in the incidence in the study population, the most recurrent being headaches with tightness or tension, back pain and pain in the cervical area. However, the stressors that generate more perception of distress to students are the methodological deficiencies of the faculty, public intervention and exams. However, there are other factors with a medium perception of distress such as overload in the student and lack of performance control(AU)

Prevalencia de sintomáticos respiratorios y factores relacionados en dos territorios vulnerables de santiago de cali / Prevalence of symptomatic respiratory disease and related factors in two vulnerable territories of santiago de cali / Prevalência de sintomático respiratório e fatores relacionados em dois territorios vulneraveís de santiago de cali

OBJETIVO: Estimar la prevalencia poblacional de sintomáticos respiratorios y los factores relacionados en los residentes de dos territorios vulnerables de la ciudad Santiago de Cali en el año 2012. MATERIALES Y MÉTODOS: Estudio descriptivo de corte transversal con componente analítico que simula la metodología tipo casos y controles. Utilizó un muestreo estratificado por conglomerados, con efecto de diseño de 2. Se realizó un análisis univariado, bivariado y múltiple a partir de regresión logística con análisis de muestras complejas para estimación de las asociaciones, se utilizó la razón odds ratio con sus respectivos intervalos de confianza y el valor de p de la prueba Chi2. Para evaluar el ajuste del modelo final, se aplicó la prueba de bondad de ajuste de Hosmer y Lemeshow. RESULTADOS: La prevalencia de sintomáticos respiratorio global fue de 2,8% (IC95%: 2,2-3,6). Se evidenció como factor de riesgo ser hombre (OR 1,51, IC95%: 1,06-2,17), residir en una vivienda con ventilación no adecuada (OR 1,97, IC95%: 1,27-3,06) y hogares con inseguridad alimentaria con hambre moderada (OR 1,63, IC95%: 1,15-2,31). Como factores protectores se identificaron aseguramiento (OR 0,41, IC95%: 0,19-0,89), ser lactante (OR 0,60, IC95%: 0,37-0,98), preescolar (OR 0,46, IC95%: 0,23-0,93), adulto maduro (OR 0,34, IC95%: 0,17-0,68) y mayor (OR 0,45, IC95%: 0,27- 0,77), respecto a los adolescentes. CONCLUSIONES: La prevalencia poblacional de sintomáticos respiratorios es diferencial de acuerdo con las condiciones de vulnerabilidad de la población, lo que implica generar indicadores programáticos en coherencia con este resultado

OBJECTIVE: To estimate the population prevalence of symptomatic respiratory disease and related factors in residents of two vulnerable areas in the city of Santiago de Cali in 2012. METHODS: Descriptive cross-sectional study with an analytical component that simulates the case-control methodology. A stratified sampling by conglomerates was used, with design effect 2. Univariate bivariate and multiple analyses were performed from logistic regression with analysis of complex samples. The odds ratio with their respective intervals of confidence and p-value of the Chi2 test were used to estimate the associations. To evaluate the fit of the final model, Hosmer and Lemeshow goodness of fit testing was applied. RESULTS: The overall population prevalence of symptomatic respiratory disease was 2.8% (CI 95% 2.2 to 3.6). Being a male (OR 1.51, CI 95%: 1.06 to 2.17), living in a house without proper ventilation (OR 1.97, CI 95%: 1.27 to 3.06) and food-insecure households with moderate hunger (OR 1.63, CI 95%: 1.15 to 2.31) were shown as a risk factors. Assurance (OR 0.41, CI 95%: 0.19 to 0.89), being a breastfed baby (OR 0.60, CI 95%: 0.37 to 0.98), being a preschooler (OR 0.46, CI 95%: 0.23 to 0.93), being a mature adult (OR 0.34, CI 95%: 0.17 to 0.68) and being elder (OR 0.45, CI 95%: 0.27 to 0.77) compared to adolescents were identified as protective factors. CONCLUSIONS: population prevalence of symptomatic respiratory disease is differential according to the vulnerability conditions of the population, which implies generating programmatical indicators consistent with this result

OBJETIVO: Avaliar a prevalência na povoação os sintomáticos respiratórios e os fatores relacionados nos residentes de dois territórios vulneráveis da cidade Santiago de Cali em o ano 2012. MATERIAIS E MÉTODOS: Estudo Descritivo de corte transversal com componente analítico que simula a metodologia tipo de casos e controles. Utilizou uma amostragem estratifico por conglomerados, com efeito de desenho de 2. Realizou se uma analise univariado, bivariado e múltiplo a partir de regressão logística com analise de amostras complexas para estimação das associações, utilizou se a razão odds ratio com seus respectivos intervalos de confiança e o valor de p da prova Chi2. Para avaliar o ajuste do modelo final, se aplicou o teste de bondade de ajuste de Hosmer e Lemeshow. RESULTADOS: a prevalência de sintomas respiratórios global foi de 2,8% (IC95%: 2,2-3,6). Evidenciou se como fator de risco for home (OR 1,51, IC95%: 1,06-2,17), (OR 1,51, IC95%: 1,06-2,17), residir em uma morada com ventilação não adequada (OR 1,97, IC95%: 1,27-3,06) e lares com insegurança alimentaria com fome moderada residir em uma morada com ventilação não adequada (OR 1,97, IC95%: 1,27-3,06) e lares com insegurança alimentaria com fome moderada (OR 1,63, IC95%: 1,15-2,31). Como fatores protetores se identificaram a salvaguarda (OR 0,41, IC95%: 0,19-0,89), ser lactante (OR 0,60, IC95%: 0,37-0,98), pré-escolar (OR 0,46, IC95%: 0,23-0,93), adulto maduro (OR 0,34, IC95%: 0,17-0,68) e maior (OR 0,45, IC95%: 0,27-0,77), respeito aos adolescentes. CONCLUSÕES: A prevalência na povoação de sintomáticos respiratórios é diferencial de acordo com as condições de vulnerabilidade da povoação, o que implica gerar indicadores programáticos em coerência com este resultado