Medición de la fuerza muscular en adultos como predictor de extubación en Unidades de Cuidados Intensivos. Revisión narrativa / Measurement of muscular strength in adults as a predicator of extubation in intensive care units. Narrative review

Resumen: Introducción: uno de los principales efectos de la ventilación mecánica invasiva es la lesión de los músculos respiratorios, específicamente, sobre el diafragma en el que pueden ocurrir alteraciones estructurales y funcionales que modifican parcial o totalmente su función. Durante la ventilación mecánica se produce un proceso de atrofia por desuso de dicho músculo. Por ello la utilidad clínica de la medición de la fuerza muscular diafragmática es importante para conocer si el paciente tiene la capacidad de activar los mecanismos protectores de la vía aérea para lograr la extubación exitosa y el retiro del ventilador mecánico en el menor tiempo posible. Objetivos: describir la medición de la fuerza muscular como predictor de la extubación en las unidades de cuidados intensivos. Material y métodos: se realizó una revisión de la literatura, entre 2011 y 2022. Resultados: los pacientes que son sometidos a ventilación mecánica invasiva prolongada generalmente desarrollan una afección muscular diafragmática, lo que se convierte en una problemática para el proceso de extubación temprana, por lo cual es vital conocer los métodos de medición de fuerza muscular como predictor de extubación.

Abstract: Introduction: one of the main effects of invasive mechanical ventilation is injury to the respiratory muscles, specifically the diaphragm. In which structural and functional alterations can occur that partially or totally modify its function. During mechanical ventilation, a process of disuse atrophy of said muscle occurs. Therefore, the clinical utility of measuring diaphragmatic muscle strength is important to know if the patient has the ability to activate the protective mechanisms of the airway to achieve successful extubation and removal of the mechanical ventilator in the shortest time possible. Objective: describe the measurement of muscle strength as a predictor of extubation in intensive care units. Material and methods: a literature review was carried out, carried out between 2011 and 2022. Results: patients who are subjected to prolonged mechanical ventilation generally develop a diaphragmatic muscle disorder, becoming a problem for the weaning, for it is important know the methods of measuring muscle strength.

Predictors of long-term healing for endorectal advancement flap for anorectal fistulas

Introduction: Anorectal fistulas are some of the commonest surgical proctologic disorders treated by surgeons. Despite the recent introduction of various sphincter preserving techniques, the search for the optimal operation continues. The purpose of this study was to determine the predictors of long-term healing for the endorectal advancement flap. Methods: A retrospective review of a single surgeon experience with the endorectal advancement flap for anorectal fistulas over an 18-year period. The impact of various patient and fistula related factors were analyzed for their impact on the primary endpoint of long-term fistula healing. Results: 87 patients underwent endorectal advancement flap (Male/Female 42.5/57.5%). Median age was 41 years. Sixty-nine patients (79.3%) had anal fistula while 18 patients had rectal fistula (20.7%). An anterior based fistula was noted in 45 patients (51.7%). The most common etiology was cryptoglandular disease (87.4%). The median operative time was 75minutes (range 36-250). Postoperative septic complications were noted in 4 patients (4.6%). Fistula healing was documented in 80 patients (93%). During a median follow-up of 4 months (range 1-38, 1 patient lost to follow-up), recurrence was noted in 8 patients (9.3%), yielding an overall long-term success rate of 83.7%. The long-term healing rate was higher in patients with fistulas from cryptoglandular etiology (86.6%) compared to fistulas from other etiologies (63.6%) [p = 0.027]. Conclusions: The endorectal advancement is associated with a high healing rate, a low postoperative septic complication rate, and infrequent risk for recurrence. Long-term healing without recurrence is achieved more frequently in patients with cryptoglandular etiology of the fistula compared to patients with non-cryptoglandular etiology. (AU)

A retrospective and comparative study between quick sequential organ failure assessment, CURB-65, and early warning scorings in COVID-19 patients to predict the disease severity and outcome

Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Materials and Methods: An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Results: The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings howed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion: We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.

Analysis of clinical features of 36 children with necrotizing pneumonia / 中国小儿急救医学

Objective:To summarize the clinical features, diagnosis, treatment, and outcomes of necrotizing pneumonia(NP)in children, so as to improve the understanding of NP.Methods:Children with NP admitted to the Children′s Medical Center of Hunan Provincial People′s Hospital from December 2012 to June 2020 were selected and divided into respiratory support group(nine cases) and non-respiratory support group(27 cases) according to whether they received respiratory support; and they were also divided into pleural effusion group(28 cases) and non-pleural effusion group(eight cases) according to whether combined with pleural effusion.The clinical data of all children were collected, and the differences between different groups were compared.Results:There were thirty-six children with NP, included 14 boys and 22 girls, with a median age of 30(12, 49) months, and the disease duration was 34(25, 42)days.All children had cough, 34 cases had fever, and the fever peak was 39.5(39.1, 40.0) ℃.Laboratory tests(all peaks) showed that blood white blood cell count was 20.77(15.65, 28.35)×10 9/L, neutrophil count was 15.11(8.52, 20.65)×10 9/L, C-reactive protein(CRP) was 104.00(23.45, 146.50)mg/L, D-dimer was 5.12(1.88, 8.04)mg/L, and lactate dehydrogenase(LDH) was 347.95(284.68, 447.81)U/L.The detection rate of pathogens was 58.33%(21/36), and the most common was Staphylococcus aureus(28.57%, 6/21). Eight cases underwent surgical treatment, including five cases of thoracoscopic surgery and three cases of thoracotomy.All patients improved and were discharged from hospital.The differences in hospital stay, white blood cell count, CRP, procalcitonin and LDH levels between respiratory support group and non-respiratory support group were statistically significant, and the median age, white blood cell count, CRP, D-dimer and LDH between pleural effusion group and non-pleural effusion group were statistically significant(all P<0.05). Further multivariate Logistic regression analysis showed that LDH was a risk factor for NP children receiving respiratory support( P<0.05), the area under the ROC curve of LDH was 0.802, whose the cut-off value was 471.21 U/L.There were no statistically significant differences in the indexes between effusion group and non-pleural effusion group. Conclusion:Children with NP are prone to repeated high fever, high inflammatory markers, and a long course of disease.Staphylococcus aureus is the most common pathogen.Serum LDH≥471.21 U/L is an early independent predictor of respiratory support for NP.

Using machine learning algorithm to predict the risk of post-traumatic stress disorder among firefighters in Changsha / 中南大学学报(医学版)

OBJECTIVES@#Firefighters are prone to suffer from psychological trauma and post-traumatic stress disorder (PTSD) in the workplace, and have a poor prognosis after PTSD. Reliable models for predicting PTSD allow for effective identification and intervention for patients with early PTSD. By collecting the psychological traits, psychological states and work situations of firefighters, this study aims to develop a machine learning algorithm with the aim of effectively and accurately identifying the onset of PTSD in firefighters, as well as detecting some important predictors of PTSD onset.@*METHODS@#This study conducted a cross-sectional survey through convenient sampling of firefighters from 20 fire brigades in Changsha, which were evenly distributed across 6 districts and Changsha County, with a total of 628 firefighters. We used the synthetic minority oversampling technique (SMOTE) to process data sets and used grid search to finish the parameter tuning. The predictive capability of several commonly used machine learning models was compared by 5-fold cross-validation and using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, precision, recall, and F1 score.@*RESULTS@#The random forest model achieved good performance in predicting PTSD with an average AUC score at 0.790. The mean accuracy of the model was 90.1%, with an F1 score of 0.945. The three most important predictors were perseverance, forced thinking, and reflective deep thinking, with weights of 0.165, 0.158, and 0.152, respectively. The next most important predictors were employment time, psychological power, and optimism.@*CONCLUSIONS@#PTSD onset prediction model for Changsha firefighters constructed by random forest has strong predictive ability, and both psychological characteristics and work situation can be used as predictors of PTSD onset risk for firefighters. In the next step of the study, validation using other large datasets is needed to ensure that the predictive models can be used in clinical setting.

Predictors of microsurgical varicocelectomy efficacy in male infertility treatment: critical assessment and systematization / 亚洲男科学杂志(英文版)

In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.

Asociación entre índice neutrófilo/linfocito como biomarcador de mortalidad en pacientes con quemaduras mayores durante el periodo del 01 de febrero de 2020 al 28 de enero de 2022 / Association between neutrophil/lymphocyte ratio as a biomarker of mortality in patientswith major burns during the period February 1, 2020 to January 28, 2022 / Associação entre a relação neutrófilo/linfócito como biomarcador de mortalidade empacientes com grandes queimaduras no período de 1º de fevereiro de 2020 a 28 de janeiro de 2022

resumen está disponible en el texto completo

Abstract: Introduction: burns are a serious public health problem, with several studies estimating that more than 11 million people were affected by burn injuries with approximately 300,000 deaths worldwide. Studies showed that the main causes of death were inhalation injuries, infection, and metabolic and hemodynamic complications ending in multi-organ failure. It has been shown that the increase in the systemic inflammatory response, whose parameters can be easily obtained, can be useful and directly related to poor prognosis. Several clinical studies indicate that the ratio of neutrophils to lymphocytes, an indicator of systemic inflammatory response, can signify the presence of inflammation in some diseases such as diabetes, coronary artery disease, cholangitis, rheumatoid arthritis, and recently COVID-19. Objective: to know the association between the neutrophil lymphocyte index as a biomarker of mortality in patients with major burns. Material and methods: an observational, retrospective, descriptive, longitudinal study will be carried out: with a user population of the National Center for Research and Attention to Burned Patients (CENIAQ) of the Luis Guillermo Ibarra Ibarra National Rehabilitation Institute. A review of the clinical records of the patients treated in the period will be carried out during the period from February 1, 2020 to February 28, 2022, the data of admission and discharge will be taken into account, as well as initial laboratory studies. The information will be recorded in an Excel spreadsheet to be later analyzed in the SPSS software, the results will be obtained and finally their analysis will be carried out. Results: in the analyzed population we found that the average age is 40 years, it was also found that the most affected gender in this population corresponds to the male gender with 81.2%. It was also found that, within the diagnoses of the population studied, fire burn was the one that most affected the population, this being 67.1% of all diagnoses. However, in this study no significant difference was found in the neutrophil lymphocyte index with respect to the type of burn. In our analysis, the neutrophil lymphocyte index was included as a biochemical predictor of mortality, since high levels of this index at admission are associated with increased mortality. In our population, a significant difference was found between the groups with a fatal clinical outcome and those who recovered, which is why it can be considered as a predictor of mortality in these patients since they presented a p value < 0.023, data that is consistent with what is reported in the international literature where the Neutrophil lymphocyte index value can be used as a predictor of mortality. Conclusions: an association was found between the elevation of the neutrophil/lynphocyte ratio and mortality in patients with severe burns.

Resumo: Introdução: as queimaduras são um grave problema de saúde pública, onde estima-se em diversos estudos que mais de 11 milhões de pessoas foram acometidas por queimaduras com aproximadamente 300.000 mortes em todo o mundo. Estudos mostraram que as principais causas de morte foram lesões inalatórias, infecções e complicações metabólicas e hemodinâmicas que culminaram em falência de múltiplos órgãos. Tem sido demonstrado que o aumento da resposta inflamatória sistêmica, cujos parâmetros podem ser facilmente obtidos, pode ser útil e estar diretamente relacionado ao mau prognóstico. Vários estudos clínicos indicam que a proporção de neutrófilos para linfócitos, um indicador de resposta inflamatória sistêmica, pode significar a presença de inflamação em algumas doenças como diabetes, doença arterial coronariana, colangite, artrite reumatóide e recentemente COVID-19. Objetivo: conhecer a associação entre o índice neutrófilo-linfócito como biomarcador de mortalidade em pacientes com grandes queimaduras. Material e métodos: será realizado um estudo observacional, descritivo, retrospectivo, longitudinal: com a população usuária do Centro Nacional de Pesquisa e Atenção ao Paciente Queimado (CENIAQ), do Instituto Nacional de Reabilitação Luis Guillermo Ibarra Ibarra. Realizaremos uma revisão dos prontuários clínicos dos pacientes atendidos no período de 1º de fevereiro de 2020 a 28 de fevereiro de 2022, serão levados em consideração os dados de admissão e alta, bem como os estudos laboratoriais iniciais. As informações serão registradas em planilha Excel para posteriormente serem analisadas no software SPSS, serão obtidos os resultados e por fim será realizada a análise. Resultados: na população analisada verificamos que a média de idade é de 40 anos, constatou-se também que o gênero mais acometido nesta população corresponde ao gênero masculino com 81.2%. Constatou-se também que, dentro dos diagnósticos da população estudada, a queimadura por fogo foi o que mais afetou a população, sendo este 67.1% do total de diagnósticos. No entanto, neste estudo não foi encontrada diferença significativa no índice neutrófilo-linfócito em relação ao tipo de queimadura. Em nossa análise, foram incluídos o índice neutrófilo-linfócito como preditor bioquímico de mortalidade, uma vez que altos níveis desse índice na admissão estão associados a aumento da mortalidade. Em nossa população, foi encontrada diferença significativa entre os grupos com desfecho clínico fatal e os recuperados, motivo pelo qual pode ser considerado como preditor de mortalidade nesses pacientes, pois apresentaram valor de p < 0.023, dado compatível com o relatado em a literatura internacional onde o valor do índice neutrófilo-linfócito pode ser utilizado como preditor de mortalidade. Conclusões: encontrou-se associação entre a elevação do índice neutrófilo/linfócito e mortalidade em pacientes com queimaduras graves.

Haematological indices and coagulation profile as predictors of disease severity and associations with clinical outcome among COVID­19 patients in Lagos, Nigeria

Background: This study aims to evaluate the use of haematological indices and coagulation profiles as possible low cost predictors of disease severity and their associations with clinical outcomes in COVID 19 hospitalized patients in Nigeria. Materials and Methods: We carried out a hospital based descriptive 3 month observational longitudinal study of 58 COVID 19 positive adult patients admitted at the Lagos University Teaching Hospital, Lagos, Nigeria. We used a structured questionnaire to obtain the participants' relevant sociodemographic and clinical data, including disease severity. Basic haematologic indices, their derivatives, and coagulation profile were obtained from patients' blood samples. Receiver Operating Characteristic (ROC) analysis was used to compare these laboratory based values with disease severity. A P < 0.05 was considered statistically significant. Results: The mean age of the patients was 54.4 ± 14.8 years. More than half of the participants were males (55.2%, n = 32) and most had at least one comorbidity (79.3%, n = 46). Significantly higher absolute neutrophil count (ANC), neutrophil­lymphocyte ratio (NLR), systemic immune inflammation index (SII), lower absolute lymphocyte count (ALC) and lymphocyte­monocyte ratio (LMR) were associated with severe disease (P< 0.05). Patients' hemoglobin concentration (P= 0.04), packed cell volume (P< 0.001), and mean cell hemoglobin concentration (P= 0.03) were also significantly associated with outcome. Receiver operating characteristic (ROC) analysis of disease severity was significant for the ANC, ALC, NLR, LMR, and SII. The coagulation profile did not show any significant associations with disease severity and outcomes in this study. Conclusion: Our findings identified haematological indices as possible low cost predictors of disease severity in COVID 19 in Nigeria

PLACENTAL ALKALINE PHOSPHATASE AS A THRESHOLD CONCEPT FOR EARLY DETECTION OF PRIMARY LUNG CANCER

The biochemical existing tool of diagnostic methods to lung cancer cases need to be improved. In order to validate an early screening of primary tumor patients, a developed a simple procedure or technique was demanded. The aims of this study were to provide an overview of alkaline Placental Alkaline Phosphatase activity in lung cancer. Using heating inactivation method regarding the measurement of Placental Alkaline Phosphatase activity as an early diagnosis marker in lung cancer cases. Total alkaline phosphatase and Placental alkaline phosphatase activity were measured in patients of Lung cancer patients who were classified according to the site of tumor by histological picture. ALP isoenzymes were identified by heat inactivation, and compared with the most frequently applied method (ELISA). Monitoring of the Total ALP and Placental ALP activity in the studied groups using two different methods were shown a highly performance of heating method by an experimental assessment to confirm the accuracy and validity of the proposed method. The distribution of serum placental ALP isoenzyme activity in patients and control groups which was measured by two different methods were found to be (20.2-43.1) IU/L respectively (measured by heating method) and (394.3- 454.5) pg/mL measured by ELISA method) respectively. Placental ALP isoenzyme showed a high significant activity in lung cancer patients than healthy control with p value less than (0.05). That application of the heat inactivation method yields similar indication to the ones obtained by the highly and specific enzyme-linked immunosorbent assay. The results of detection Placental alkaline phosphatase in serum were in excellent agreement and could have a potentially extensive application for Placental alkaline phosphatase quantification.

Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) in Predicting Mortality and Morbidity in NICU.

Introduction: A number of illness severity scores have evolved which would predict mortality and morbidity in intensive care units. One such scoring system developed by Richardson was SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal extension-II). The present study was undertaken to determine the validity of SNAPPE II score in predicting outcome in terms of mortality and also determine morbidity in terms of duration of hospital stay using SNAPPE II score. Method: This prospective observational study was conducted in 186 neonates in Neonatal Intensive Care Unit (NICU), Department of Paediatrics, SNMC & HSK Hospital and Research centre, Bagalkot from 1st Dec 2016 to 31st May 2018. At admission, detailed clinical assessment of the baby was performed and recorded within 12 hours of admission in a pre-designed questionnaire. All the babies were subjected blood gas analysis to get pH and PaO2. And hence PaO2/ FiO2 ratio was calculated. Outcome was recorded based on baby’s survival and duration of hospital stay. Results: SNAPPE II score was higher among expired babies compared to survived babies. A mean score of 45.6 was associated with higher mortality had a sensitivity of 82.9%, specificity of 98.0%, positive predictive value of 90.2% and negative predictive value of 96.1%. AUC in ROC was found to be 0.960. Increased score resulted in increased duration of hospital stay. Conclusion: SNAPPE II score is a good predictor of neonatal mortality and morbidity in terms of duration of hospital stay.

Assessment of Predictors of Infection in Primary Knee and Hip Arthroplasty: A Case-control Study / Avaliação de fatores preditores de infecção na artroplastia primária de joelho e quadril: Um estudo caso-controle

Abstract Objective This study assesses risk factors for periprosthetic joint infection after elective primary total knee or hip arthroplasty. Methods The study included 706 medical records of patients undergoing elective primary total hip or knee arthroplasty from January to December 2018. We used a multivariate analysis of infection predictors through a logistic regression model. The R software performed all statistical analysis. Results The prevalence of infection in the sample was 2.0% (14 cases). Most patients were women (79.6%), with an afflicted right side (50.6%), and underwent a total knee arthroplasty (61.3%). Significant risk factors (p< 0.05) for infection included surgical time greater than 120 minutes (p= 0.009) and a history of diabetes (p= 0.025). Conclusion The risk of infection after elective primary total knee or hip arthroplasty is higher when the surgical procedure is lengthy (over 120 minutes), or the patient has a history of diabetes mellitus. Level of EvidenceIIIB, retrospective, case-control study.

Resumo Objetivo Avaliar os fatores de risco para infecção articular periprotética após procedimento cirúrgico eletivo de artroplastia primária total de joelho ou quadril. Métodos Incluem-se no estudo 706 prontuários de pacientes que foram submetidos a artroplastia total primária eletiva de quadril ou joelho entre os meses de janeiro e dezembro de 2018. Utilizou-se a análise multivariada dos fatores preditores de infecção por meio de um modelo de regressão logística. Toda a análise estatística foi realizada no software R. Resultados A prevalência de infecção de toda a amostra foi de 2,0% (14 casos). A amostra contou com a maioria do gênero feminino (79,6%), com o lado direito afetado (50,6%) e predomínio da artroplastia total de joelho (61,3%). Os fatores de risco significativos (p< 0,05) para a infecção foram: tempo cirúrgico maior do que 120 minutos (p= 0,009) e diagnóstico prévio de diabetes (p= 0,025). Conclusão Artroplastias totais primárias eletivas de joelho ou quadril possuem maior risco de infecção quando ocorre um tempo prolongado do procedimento cirúrgico (acima de 120 minutos) e quando o paciente possui diagnóstico prévio de diabetes mellitus. Nível de EvidênciaIIIB, estudo retrospectivo caso-controle.

Factors Associated with Maternal Near-miss Among Women Admitted in A Rural Hospital: A Single-Center Study

Background: Maternal Near-miss (MNM) is one of the related concepts to maternal mortality. MNM is a special category of survivors, whose stories provide unique insights and valuable information on maternal mortality. Characterizing near-miss morbidity is valuable for monitoring the quality of hospital-based obstetric care and should be calculated regularly for planning, monitoring, and evaluating provided maternal healthcare. Objectives: The study aimed to observe the factors like patterns and predictors related to maternal near-miss in our demographic.Material & Methods:This cross-sectional observational study was conducted at the Department of Obstetrics and gynaecology, Sirajgonj Medical College and Hospital, Sirajgonj, Bangladesh. The study duration was 1 year, from June 2019 to May 2020. During the study period, a total of 1277 deliveries were conducted at the study hospital, among which, 69 cases were of MNM. Results:The rate of maternal near-miss in our study was 5.41% of the total admitted maternal pregnancy cases. The maternal near-miss mortality ratio (MNM: 1 MD) was 1:13.8. Out of the 69 near-miss cases, 82.6% of women met the MNM criteria already at admission, and another 17.4% of near-miss cases were distributed: 10.1% developed near-miss after admission within the first 12 hours of the hospital admission, whereas the occurrence of MNM after 12 hours of the hospital admission was observed in 7.3% of cases. Conclusions:MNM cases are alarmingly high. Hypertensive disorders of pregnancy and obstetric hemorrhage were the two main direct obstetric causes of near-misses that require strict and quick management protocols. A proper antenatal check-up to discourage early marriage and pregnancy and timely referral to well-equipped health facilities with logistic support is necessary for saving human life.

Predictores de potenciales reacciones adversas e interacciones medicamentosas en pacientes post accidente cerebrovascular en Perú

Objetivo Identificar los predictores clínicos y farmacoterapéuticos asociados a los niveles de severidad de las reacciones adversas (RAM) e interacciones medicamentosas (IM) en pacientes hospitalizados post accidente cerebrovascular. Métodos Estudio analítico, predictivo y transversal mediante el modelo de regresión lineal múltiple. Los niveles de severidad de las potenciales reacciones adversas e interacciones medicamentosas se evaluaron mediante Drugs.com. Resultados De la evaluación de 992 prescripciones médicas de 55 (56,7%) pacientes mujeres y 42 (43,3%) varones post accidente cerebrovascular isquémico 62 (63,9%) y hemorrágico 35 (36,1%), se identificó un total de 11 790±46,8 potenciales reacciones adversas y 1 034±9,8 interacciones medicamentosas. La hipertensión arterial se asoció a las reacciones adversas graves y moderadas, en tanto que la neumonía intrahospitalaria y alcalosis metabólica a reacciones adversas leves y moderadas. La alcalosis metabólica se asoció a las interacciones medicamentosas moderadas y leves. Los predictores farmacoterapéuticos como la prescripción en polifarmacia y el uso de antibióticos se relacionaron con reacciones adversas graves, moderadas y leves; los antidiabéticos se relacionaron con interacciones medicamentosas graves, moderadas y los fármacos para terapia cardiaca con interacciones medicamentosas leves. Conclusiones Las variables clínicas como factores de riesgo cardiovascular, presencia de comorbilidades que exacerban las enfermedades crónicas no trasmisibles, los signos y síntomas de alarma, el mayor tiempo de estancia hospitalaria y la prescripción en polifarmacia fueron predictores de mayor frecuencia de reacciones adversas e interacciones medicamentosas graves y moderadas que requieren especial vigilancia y estudio individualizado.

Objective To identify clinical and pharmacotherapeutic predictors associated with severity levels of adverse reactions and drug-drug interactions in post-stroke hospita-lized patients. Methods Analytic, predictive, cross-sectional study using multiple linear regression modeling. Severity levels of potential adverse reactions and drug-drug interactions were assessed using Drugs.com. Results From the evaluation of 992 medical prescriptions of 55 (56.7%) female and 42 (43.3%) male patients post ischemic stroke 62(63.9%) and hemorrhagic stroke 35 (36.1%); a total of 11 790±46.8 potential adverse reactions and 1 034±9.8 drug-drug interactions were identified; arterial hypertension was associated with severe and moderate adverse reactions; while in-hospital pneumonia and metabolic alkalosis with mild and moderate adverse reactions. While metabolic alkalosis was associated with moderate and mild drug-drug interactions. Pharmacotherapeutic predictors such as polypharmacy prescription and antibiotic use were related to moderate and mild severe adverse reactions; antidiabetic drugs were related to moderate and severe drug-drug interactions and cardiac therapy drugs were related to mild drug-drug interactions. Conclusions Clinical variables such as cardiovascular risk factors, presence of comorbidities that exacerbate chronic noncommunicable diseases, alarm signs and symptoms, longer hospital stay, as well as polypharmacy prescriptions, were predictors of a higher frequency of severe and moderate adverse reactions and drug-drug interactions, which require special vigilance and individualized study.

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

Predictores de complicaciones y muerte en pacientes con esofagectomía por cáncer de esófago / Predictors of complications and death in patients with esophagectomy due to esophagus cancer

Introducción: La morbilidad y la mortalidad continúan siendo altas a escala mundial como consecuencia de la esofagectomía programada por cáncer de esófago. Objetivo: Identificar los factores predictores de complicaciones posquirúrgicas y de muerte, la estadía hospitalaria y las causas de muerte en la población estudiada. Método: Se efectuó un estudio de cohorte de 81 pacientes con diagnóstico de cáncer de esófago, atendidos en los hospitales Saturnino Lora y Dr. Juan Bruno Zayas Alfonso de la provincia de Santiago de Cuba desde enero de 2010 hasta diciembre de 2019, de los cuales se escogió una muestra aleatoria de 68. Para identificar los factores predictivos asociados con las complicaciones y la mortalidad se definieron 2 cohortes de enfermos: los expuestos y los no expuestos a los factores de interés, tales como la realización de toracotomía, las reintervenciones, además de las complicaciones médicas y quirúrgicas infecciosas. Se utilizó el método estadístico de bondad de ajuste de Hosmer-Lemeshow con un nivel de significación α= 0,10. Resultados: Si se realiza toracotomía, la probabilidad de que se desarrollen complicaciones quirúrgicas infecciosas es 2,3 veces mayor que si no se lleva a cabo el proceder; asimismo, el riesgo de fallecer por dichas complicaciones (p=0,024), en contraposición a cuando no se presentan, asciende a 370,0 % (IC 90 %: 1,5-14,8). Conclusión: La realización de toracotomía se establece como factor predictor de complicaciones y la presencia de reintervenciones y de complicaciones médicas y quirúrgicas infecciosas como predictores de muerte en la esofagectomía programada.

Introduction: Morbidity and mortality continue being high worldwide as consequence of the esophagectomy programmed due to esophagus cancer. Objective: To identify the predictor factors of postsurgical and death complications, hospitalization and death causes in the studied population. Method: A cohort study of 81 patients with diagnosis of esophagus cancer was carried out. They were assisted in Saturnino Lora and Dr. Juan Bruno Zayas Alfonso hospitals in the province of Santiago de Cuba from January, 2010 to December, 2019, of which a random sample of 68 was chosen. To identify the prediction factors associated with the complications and mortality 2 cohorts of sick patients were defined: the exposed and those not exposed to interest factors, such as the thoracotomy realization, reinterventions, besides the infectious medical and surgical complications. The statistical method of Hosmer-Lemeshow was used with a significance level of α = 0,10. Results: If thoracotomy is carried out, the probability that infectious surgical complications are developed is 2.3 times more that if it is not carried out; also, the risk of dying due to this complications (p=0.024), in opposition to when they are not presented, ascends to 370.0 % (IC 90 %: 1.5-14.8). Conclusion: The thoracotomy realization is established as predictor factor of complications and the presence of reinterventions and infectious medical and surgical complications as death predictors in the programmed esophagectomy.

Valoración de la Escala News (National Early Warning Score) como predictor de sepsis en pacientes con síndrome febril. Servicio Medicina Interna, Hospital Salvador Bienvenido Gautier, agosto-diciembre 2019 / News (National Early Warning Score) scale assessment as sepsis predictor in patients with febril syndrome. Internal Medicine Emergency Department, Salvador Bienvenido Gautier Hospital, August-December 2019

Introducción: la utilización de la escala NEWS podría construir una herramienta en el diagnóstico, pronóstico y estratificación precoz ante la sospecha de sepsis. El propósito de esta investigación fue determinar la eficacia de la escala NEWS como predictor de sepsis en pacientes ingresados por síndrome febril en el Hospital Salvador Bienvenido Gautier, en el período de octubre-diciembre 2019. Material y método: se realizó un estudio descriptivo, prospectivo y de corte transversal donde la técnica utilizada para la recolección de la información fue la evaluación directa de los 43 pacientes admitidos aplicando la escala NEWS y revisión de expedientes clínicos. Resultados: se determinó que el punto de corte ≥6 en la escala NEWS obtuvo valores de sensibilidad (91 %), especificidad (70 %), índice de Youden de 0.61, valor predictivo positivo de 78 %, valor predictivo negativo de 88 %, razón de verosimilitud positiva de 3 y negativa de 0.1. La aplicación de la escala NEWS en el sexo masculino presentó una sensibilidad de 92.9 % y especificidad de 87.5 %. En los grupos de 18-30 y 71-80 años, esta escala presentó una sensibilidad y especificidad de 100 %. Los pacientes clasificados como riesgo bajo, moderado y alto fueron diagnosticados con sepsis el 16.67 %, 63.64 % y un 70 %, respectivamente. Conclusiones: una puntuación mayor o igual a 6 en la escala NEWS se presenta como un predictor estadísticamente significativo que ayudaría en el diagnóstico temprano de sepsis, siendo más sensible que especifica. Fue mejor predictor en el sexo masculino y en los grupos etarios de 18-30 y 71-80 años

Introduction: The use of the NEWS could build a tool in the diagnosis, prognosis and early stratification in case of suspected sepsis. The purpose of this research was to determine the efficacy of the NEWS as a predictor of sepsis in patients admitted for febrile syndrome at the Salvador Bienvenido Gautier Hospital, October-December 2019. Materials and methods: A descriptive, prospective and crosssectional study was conducted where the technique used for the collection of the information was the direct evaluation of the 43 admitted patients applying the NEWS and the review of clinical records. Results: It was determined that the cutoff point ≥6 on the NEWS obtained sensitivity value (91%), specificity (70%), Youden index of 0.61, positive predictive value of 78%, negative predictive value of 88%, ratio of positive likelihood of 3 and negative of 0.1. The application of the NEWS scale in males presented a sensitivity of 92.9% and specificity of 87.5%. In the groups of 18-30 and 71-80 years, this scale presented a sensitivity and specificity of 100%. Patients classified as low, moderate and high risk were diagnosed with sepsis 16.67%, 63.64% and 70% respectively. Conclusions: A score greater than or equal to 6 on the NEWS is presented as a statistically significant predictor that would help in the early diagnosis of sepsis being more sensitive than specific. It was a better predictor in the male sex and in the age groups of 18-30 and 71-80 years

Risk analysis of brain metastases in limited-stage small cell lung cancer (LS-SCLC)achieving complete remission after thoracic radio-chemotherapy / 中华放射肿瘤学杂志

Objective:Small cell lung cancer (SCLC) is a highly malignant tumor with a high risk of brain metastasis (BMs). The purpose of this study was to evaluate the clinical factors affecting the occurrence of BMs in patients with stage IIB-IIIB SCLC who achieved complete remission (CR) after thoracic radio-chemotherapy.Methods:Clinical data of 191 patients with stage IIB-IIIB SCLC who achieved CR after thoracic radio-chemotherapy in Zhejiang Cancer Hospital from January 2009 to April 2016 were retrospectively analyzed. Common clinical factors related to the risk of BMs, including gender, age, thoracic radiotherapy dose, combined mode of radiotherapy and chemotherapy, pretreatment serum NSE and LDH, whether PCI was performed, TMN stage and PS score, were analyzed using log-rank method for univariate analysis, COX regression method for multivariate analysis and Kaplan-Meier method to plot the survival curve.Results:Univariate analysis showed that pretreatment LDH level≥240IU, pretreatment NSE ≥17 ng/ml and no PCI were positively correlated with the risk of BMs (all P＜0.05). Multivariate analysis showed that the risk of BMs was only positively correlated with pretreatment LDH≥240IU [HR: 1.90, 95%CI(1.07-3.37), P=0.029], and no PCI [HR:2.08, 95%CI(1.17-3.72), P=0.013]. Conclusion:Pretreatment serum LDH levels provide important value for predicting the risk of BMs in patients with stage IIB-IIIB SCLC who achieve CR after thoracic radio-chemotherapy.

Weaning and extubation in neurocritical care patients / 中华危重病急救医学

Due to primary diseases of neurocritical care unit (NCU) patients, they have particularities with low level of consciousness, poor airway protective ability, damaged respiratory drive and respiratory motor conduction pathway. Such patients have higher rates of weaning difficulty, delayed extubation, extubation failure and tracheostomy. There are several guidelines on weaning and extubation for intensive care unit (ICU) patients, while there are no guidelines for for NCU patients. Therefore, we reviewed current guidelines and recommendations on weaning and extubation in both ICU and NCU patients suggesting considerations of neurological condition, level of consciousness and presence of airway protective reflexes before extubation, moreover, we introduced researches about protocols of weaning for NCU patients and related predictors.

Asociación de los grados de movilidad de la articulación atlanto-occipital con la clasificación de Cormack- Lehane como predictores de una vía aérea pediátrica difícil en pacientes de 0 a 12 años de edad en el Hospital Municipal Boliviano Holandés, 2017 / Association of the degrees of mobility of the atlanto-occipital joint with the Cormack-Lehane classification as predictors of a difficult pediatric airway in patients aged 0 to 12 years at the" Municipal Boliviano Holandés" Hospital, 2017

OBJETIVO. Determinar la asociación que existe entre las valoraciones de la articulación atlantooccipital durante la valoración preanestésica y la valoración del Cormack Lehane durante la intubación para predecir una vía aérea difícil en el paciente pediátrico de 0 a 12 años de edad que ingresaron a quirófano del Hospital Municipal Boliviano Holandés en los meses de agosto a octubre de la Gestión 2017. MATERIAL Y METODOS. Es un diseño observacional descriptivo de corte transversal, en 70 pacientes de 0 a 12 años de edad que siguiendo criterios estrictos de inclusión se evaluó la clasificación de vía aérea difícil pediátrica analizando la concordancia entre la asociación de la valoración de la articulación atlantooccipital con la escala de Cormack-Lehane. RESULTADOS. Se evaluaron pacientes entre 0 a 12 años, la Escala de Bellhouse Dore encontrada fue Grado I 39%, Grado III 29%, Grado II 24% y Grado IV 8% y el Cormack Lehane encontrado es grado I 39%, grado III 29%, grado II 24% y el grado IV 8%. La asociación de ambas escalas determinó como predictor de vía aérea normal al 63%, potencialmente difícil 29% y vía aérea difícil 8%. CONCLUSIÓN. Existe asociación entre las valoraciones de la articulación atlantooccipital durante la valoración preanestesica y la valoración del Cormack Lehane durante la intubación como predictor de una vía aérea difícil en el paciente pediátrico de 0 a 12 años de edad.

OBJECTIVE. To determine the association that exists between the assessments of the atlanto-occipital joint during the preanesthetic assessment and the assessment of the Cormack Lehane during intubation to predict a difficult airway in pediatric patients aged 0 to 12 who were admitted to the Municipal Boliviano Holandés Hospital in the months of August to October of the Management 2017. MATERIAL AND METHODS. It is an observational descriptive crosssectional design, in 70 patients from 0 to 12 years of age who, following strict inclusion criteria, evaluated the classification of pediatric difficult airway, analyzing the concordance between the association of the atlanto-occipital joint assessment with the Cormack-Lehane scale. RESULTS. Patients between 0 to 12 years old were evaluated, the Bellhouse Dore Scale found was Grade I 39%, Grade III 29%, Grade II 24% and Grade IV 8% and the Cormack Lehane found is grade I 39%, grade III 29 %, grade II 24% and grade IV 8%. The association of both scales determined a 63% normal airway as a predictor, 29% potentially difficult and 8% difficult airway. CONCLUSION. There is an association between the assessments of the atlanto-occipital joint during the pre-anesthetic assessment and the assessment of the Cormack Lehane during intubation as a predictor of a difficult airway in pediatric patients 0 to 12 years of age.

Prevalence and predictor stunting, wasting and underweight in Timor Leste children under five years: An analysis of DHS data in 2016

Stunting, wasting, and being underweight are indicators of malnutrition in a country. The high status reflects the poor nutritional and health status of children under five. We analyzed data from the Demographic and Health Survey conducted in Timor Leste from 2009 to 2016 to identify the prevalence and predictor stunting, wasting, and underweight. The variables analyzed were the mother's education, mother's age, mother BMI, mother's height, number of ANC visits, birth weight, sex of a child, sex of head household, type of residence, wealth index, toilet facility, source of drinking water and province. The sample in this study was 3,723 toddlers. Prevalence of stunting (44.4%), underweight (37.5%) and wasting (25.3%). In the bivariate analysis, the variables statistically significantly associated with stunting, underweight, and wasting was mother's education, sex of a child, type of residence, wealth index, and province. Improving the nutritional status of children in Timor Leste requires various nutrition and health interventions