ABSTRACT
ABSTRACT Background: Severe pneumonia is the most common cause of intensive care unit (ICU) admission and death due to novel coronavirus (SARS-CoV-2) respiratory disease (COVID-19). Due to its rapid outbreak, units for the evaluation of febrile patients in the pre-hospital setting were created. Objective: The objective of the study was to develop a sensitive and simple tool to assess the risk of pneumonia in COVID-19 patients and thus select which patients would require a chest imaging study. Materials and Methods: We conducted a cross-sectional study in a cohort of individuals with suspected COVID-19 evaluated in a public academic healthcare center in Buenos Aires city. All adult patients with positive RT-PCR assay for SARS-COV2 between April 24 and May 19 of 2020 were included in the study. Pneumonia was defined as the presence of compatible signs and symptoms with imaging confirmation. Univariate and multivariate logistic regression was performed. A risk indicator score was developed. Results: One hundred and forty-eight patients were included, 71 (48%) received the diagnosis of pneumonia. The final clinical model included four variables: age ≥ 40 years, cough, absence of sore throat, and respiratory rate ≥ 22. To create the score, we assigned values to the variables according to their ORs: 2 points for respiratory rate ≥ 22 and 1 point to the other variables. The AUC of the ROC curve was 0.80 (CI 95% 0.73-0.86). A cutoff value of 2 showed a sensitivity of 95.7% and a specificity of 43.24%. Conclusion: This sensible score may improve the risk stratification of COVID-19 patients in the pre-hospital setting. (REV INVEST CLIN. 2021;73(1):52-8)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Pneumonia, Viral/diagnosis , Fever/diagnosis , COVID-19/complications , Intensive Care Units , Argentina , Pneumonia, Viral/etiology , Severity of Illness Index , Risk , Cross-Sectional Studies , Prospective Studies , Cohort Studies , Sensitivity and Specificity , Reverse Transcriptase Polymerase Chain Reaction , Fever/virology , COVID-19/diagnosisABSTRACT
Objetivo: informar un caso de absceso cerebral odontogénico secundario a bacteriemia posraspaje radicular y revisar el tratamiento de esta patología poco frecuente. Caso clínico: un paciente de sexo masculino, de 57 años de edad, con antecedentes de diabetes tipo II mal controlada, fue intervenido mediante una limpieza gingival con cavitador ultrasónico, sin profilaxis antibiótica. A las 2 semanas, evolucionó con cefalea, fiebre y deterioro del sensorio. Al ingresar al hospital, se le realizó una resonancia cerebral que evidenció imagen compatible con absceso temporomesial izquierdo. Se efectuó la evacuación quirúrgica bajo guía estereotáxica y se rescató material purulento con cultivos positivos para Streptococcus milleri. Se indicó un tratamiento antibiótico con ceftriaxona y metronidazol. El paciente evolucionó con mejoría sintomática, sin déficit neurológico y sin lesión, según la imagen por resonancia magnética de control. Conclusión: los abscesos cerebrales constituyen una patología con alta morbimortalidad. Aunque el origen odontogénico es raro, es necesario evaluar a los pacientes con comorbilidades -como la inmunosupresión- y someterlos a prácticas habituales de bajo riesgo, a fin de minimizar probables complicaciones asociadas.