Depuración del lactato y mortalidad en residentes de la gran altitud con trauma grave / Lactate clearance and mortality in high altitude residents with severe trauma

Introducción: Diversos estudios reportan que la depuración del lactato está asociado a la mortalidad en los pacientes críticos. Se describe la relación entre la depuración del lactato y la normalización del lactato con la mortalidad en los pacientes residentes de la gran altitud con trauma grave. Por lo cual es importante conocer la mortalidad de los pacientes con trauma grave en la altitud y la distribución lesional del trauma grave en la altitud. Material y Métodos: Estudio de cohorte, retrospectivo, realizado en una unidad de cuidados intensivos a 4,150 "msnm" en pacientes que ingresaron por trauma grave. Los criterios de inclusión fueron: a) Diagnóstico de trauma grave. b) Injury severity score mayor a 16. c) Presencia del resultado del análisis del lactato al ingreso y a las 6 horas en UCI y d) Residente de la altitud desde los 12 años. Se excluyeron los pacientes con historias clínicas incompletas y no legibles. Resultados: Se incluyeron 160 pacientes, Mortalidad del 15%, 65% de las lesiones fueron por trauma encefálico grave. En el grupo de supervivientes (n=136), la depuración de lactato fue del 52,27% y en el grupo de fallecidos fue 21,38%. En relación a la normalización (lactato< 2 mmol/L), el grupo de supervivientes tuvo 47% frente a 1% de los fallecidos. Conclusiones: La depuración de lactato y la normalización del lactato a las 6 seis horas son factores de protección para disminuir la mortalidad por trauma grave. La mortalidad por trauma grave es 15%. El trauma encefálico grave fue la lesión más frecuente.

Background: Several studies report that lactate clearance is associated with mortality in critically ill patients. Objectives: To describe the relationship between lactate clearance and lactate normalization with mortality in high-altitude resident patients with severe trauma. To know the mortality of patients with severe trauma at altitude. Know the injury distribution of severe trauma at altitude. Material and Methods: Epidemiological, observational, analytical, cohort, retrospective study, carried out in an intensive care unit located at 4,150 "masl" in patients admitted for severe trauma. The inclusion criteria were: a) Diagnosis of severe trauma. b) Injury severity score greater than 16. c) Presence of the result of the lactate analysis at admission and at 6 hours in the ICU and d) Resident of the altitude since the age of 12. Patients with incomplete and unreadable medical records were excluded. Results: 160 patients were included, mortality of 15%, 65% of the injuries were due to severe brain trauma. In the group of survivors (136), lactate clearance was 52.27% and in the group of deceased it was 21.38%. In relation to normalization (lactate <2 mmol / L), the group of survivors had 47% compared to 1% of the deceased. Conclusions: Lactate clearance and lactate normalization at 6 hours are protective factors to decrease mortality from severe trauma. Mortality from severe trauma is 15%. Severe head trauma was the most frequent injury.

Molecular indentification of Trypanosoma cruzi in Didelphis marsupialis and Rattus spp. in an old endemic area of chagas disease in Lara state, Venezuela

During the period from October 1996 to October 1998, captures of mammals were made in two places with different ecological characteristics, La Matica and Tintinal, searching for reservoirs of Trypanosoma cruzi. A total of 513 animals, belonging to 10 different genera, were captured. Blood was extracted from them by cardiac puncture, to carry out examinations in fresh and culture in blood agar base medium. Xenodiagnosis was also carried out on a limited number of animals. Two different species were found naturally infected with T. cruzi, opossums (Didelphis marsupialis) and black rats (Rattusspp.). In D. marsupialis the presence of T. cruzi was determined in 9 of the 31 animals studied (29.03 por ciento). Rattus was found to be infected in 4.41 por ciento (3/68). Five cultures (2 from D. marsupialis and 3 from Rattus spp.) were characterized as T. cruzi by means of the kDNA restriction pattern and hybridization with species-specific probes. When we studied the D. marsupialis according to the place of capture, we found that the infection in Tintinal was present in 57.14 por ciento (8/14) of the animals studied, while in La Matica it scarcely represented 5.88por ciento (1/17). These differences were statistically significant. (p menor que 0.05). Finally, the inclusion of a ôprevalence index of T. cruzi in reservoirsõ is suggested, as an additional measure to predict the real situation of an endemic area