Autopsy findings of fatal retroperitoneal hemorrhage after traumatic rupture of bilateral renal angiomyolipoma

ABSTRACT The present work reports the autopsy findings of a unique case characterized by fatal retroperitoneal hemorrhage following the traumatic rupture of bilateral renal angiomyolipomas. Renal angiomyolipomas are generally benign tumors with an unpredictable clinical course, ranging from asymptomatic to sudden rupture and hemorrhagic shock. They may be associated with genetic disorders such as tuberous sclerosis complex. The case under investigation is unprecedented in the medical literature due to its bilateral nature and fatal outcome. Autopsy analysis revealed an extensive retroperitoneal hemorrhage originating from bilateral ruptured tumors. Microscopic examination found features consistent with bilateral renal angiomyolipoma. Circumstantial information identified a traffic accident before the death, considering it as the cause of the tumors' traumatic rupture. In this case, due to the severity of the situation, immediate medical measures—such as fluid resuscitation, coagulopathy correction, and surgical treatment, which are usually lifesaving—could not be performed. This led to the patient being declared dead at the scene of the crash.

Pediatric inflammatory multisystemic syndrome in Brazil: sociodemographic characteristics and risk factors to death

Abstract Objective: To determine the incidence of MIS-C in Brazil, describe the clinical and sociodemographic characteristics of the pediatric population affected by MIS-C and compare mortality and lethality outcomes with isolated Covid-19 and MIS-C cases. Methods: Observational and retrospective cohort study of cases of MIS-C associated with Covid-19 in the Brazilian population between 04/01/2020 and 04/17/2021. Data from the Ministry of Health's epidemiological bulletin up to the 15th epidemiological week of 2021, were used. The analyzes were descriptive through absolute and relative frequencies. The significance level is 5% in Stata 16.0 package. Results: Between 04/01/2020 and 04/07/2021, 903 cases of MIS-C associated with Covid-19 were notified in Brazil, of which, the largest part (55.26%) were male, between 0 and 4 years old (45.29%), from the Southeast region (38.76%). The deaths (61; 6.7%) were higher in the female gender, between 0 and 4 years old (47.54%) and in the Southeast region (34.43%). It was identified that the risk of death by MIS-C related to Covid-19 is 5.29 (CI = 2.83; 9.87 and P-value = <0.001) times higher in adolescents from 15-19 years old than in other age groups when compared to 0-4 years old children. Also, the residency in North region was as risk factor to death (RR = 3.72, IC = 1.29; 10.74 e P-value = 0.008). Conclusion: In this study, despite the numbers showing more deaths from zero to 4 years old, the risk for teenagers is notably higher. In addition, Brazil's Northern region is a risk factor that reaffirms social inequality and poor access to health.

Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report

ABSTRACT Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.

Hallazgos en imágenes de tórax en una intoxicación aguda con paraquat: reporte de un caso / Findings on thorax images in acute paraquat poisoning: case report

Resumen El Paraquat es un herbicida ampliamente utilizado para el control de las malezas en Chile. Su ingesta determina una alta probabilidad de mortalidad dado su inherente toxicidad mediante la producción de radicales libres, que afectan a múltiples órganos, principalmente los pulmones; a esto se suma la falta de un tratamiento efectivo. Se presenta el caso clínico de un hombre de 18 años que en un intento suicida consume 50 mL de paraquat (200 g/L), con desenlace fatal. La presentación clínica depende la cantidad de Paraquat ingerida y los hallazgos radiológicos descritos varían según la temporalidad del cuadro e, inclusive, podrían determinar el pronóstico.

Paraquat is an herbicide widely used for weed control in Chile. Its intake determines a high probability of mortality because of its inherent toxicity through the production of free radicals. Multiple organs are affected, mainly the lungs; to this is added the lack of effective treatment. We present the clinical case of an 18-year-old man who in a suicidal attempt swallows 50 mL of paraquat (200 g/L), with a fatal outcome. The clinical presentation depends on the amount of Paraquat ingested. Radiological findings described vary according to the temporality of the condition and could even determine the prognosis

Educação em saúde e final de vida no hospital / Educación en salud y final de la vida en el hospital / Health education and end-of-life at a hospital

Introdução: ações de educação em saúde são incipientes em alguns hospitais. Quando se trata de realizá-las em situações de final de vida, as equipes apresentam limitações. Objetivo: identificar ações de educação em saúde direcionadas às pessoas em final da vida e seus cuidadores, informais e formais, no hospital, além de avaliar o nível de evidência de tais ações. Síntese do conteúdo: o estudo foi realizado entre dezembro de 2019 e janeiro de 2020, nas bases de dados Web of Science, Scopus e Medline. Identificaram-se 6.762 artigos, dos quais 42 integram a análise por serem artigos originais ou de revisão escritos em português, espanhol, inglês ou francês; a amostra dos estudos foi composta por pacientes maiores de 19 anos, com doença avançada e/ou em final de vida ou cuidadores ou profissionais de saúde. Os dados foram agrupados por similaridade do tema das ações, conforme Polit e Beck, e o nível de evidência avaliado segundo Melnyk e Fineout-Overholt. O vídeo foi a ação com maior força de recomendação, seguida por cartilhas. As unidades temáticas foram "Ações para o controle da dor", "Narrativas sobre o final da vida", "Planejamento de cuidados", "Dialogando sobre os cuidados paliativos" e "Comunicação e final de vida". Conclusões: ações de educação em saúde no final da vida devem considerar as tecnologias da informação e da comunicação, além das condições socioculturais, clínicas e cognitivas dessa etapa do adoecimento

Introducción: las acciones de educación para la salud son incipientes en algunos hospitales. Cuando se trata de desplegar estas acciones al final de la vida, los equipos encargados tienen ciertas limitaciones. Objetivo: identificar acciones de educación en salud dirigidas a pacientes intrahospitalarios en el final de la vida y a sus cuidadores (formales e informales), así como evaluar la evidencia de tales acciones. Síntesis de contenido: el estudio se llevó a cabo entre diciembre de 2019 y enero de 2020 en las bases de datos Web of Science, Scopus y MEDLINE. Se identificaron 6.762 artículos, de los cuales 42 forman parte del análisis por ser artículos originales o de revisión escritos en portugués, español, inglés o francés, cuya muestra estuvo conformada por pacientes mayores de 19 años con enfermedad avanzada a al final de la vida, o sus cuidadores o los profesionales de la salud encargados de su cuidado. Los datos fueron agrupados por similitud de las acciones, siguiendo a Polit y Beck, y el nivel de evidencia evaluado, según Melnyk y Fineout-Overholt. El video fue la acción más recomendada, seguida de los folletos. Las unidades temáticas fueron "Acciones para el control del dolor", "Narrativas sobre el final de la vida", "Planificación anticipada de cuidados", "Diálogo sobre cuidados paliativos" y "Comunicación y final de la vida". Conclusiones: las acciones de educación en salud al final de la vida deben considerar las tecnologías de la información y la comunicación, además de las condiciones socioculturales, clínicas y cognitivas durante esta etapa de la enfermedad

Introduction: Health education actions are a challenge in some hospitals. When it comes to performing such actions in the face of end-of-life situations, health teams have some limitations. Objective: To identify health education actions for in-hospital dying patients and their informal and formal caregivers, and to assess the level of evidence of such actions. Content synthesis: Study conducted between December 2019 and January 2020, in the databases Web of Science, Scopus and MEDLINE. A total of 6.762 articles were identified. Among these, 42 articles were considered as they met the following inclusion criteria: original or review article written in Portuguese, Spanish, English, or French, whose sample consisted of patients over 19 years with a terminal disease or at the end of their lives, or their caregivers or health professionals in charge of their care. The data were grouped by similarity of the actions deployed, following Polit and Beck, and the level of evidence evaluated, according to Melnyk and Fineout-Overholt. The video was the action with greater force of recommendation, followed by booklets. The thematic units were: "Actions for pain control", "Narratives about the end-of-life", "Advance care planning", "Talking about palliative care", and "Communication and end-of-life". Conclusions: Health education actions at the end of life should consider information and communication technologies, in addition to the sociocultural, clinical, and cognitive conditions during this stage.

Análise dos desfechos maternos e fetais relacionados à COVID-19 durante a gestação / Analysis of maternal and fetal outcomes related to COVID-19 during pregnancy

O SARS-CoV-2 é um vírus RNA transmitido pelo contato direto ou indireto por gotículas infectadas. No que se refere à COVID-19 e à gestação, referências apontam que nesse período as mulheres possuem maior susceptibilidade a complicações obstétricas e perinatais. O presente estudo objetiva compreender e compilar aspectos da infecção e os principais desfechos negativos maternos e fetais documentados na literatura atual, relacionados à infecção pelo novo coronavírus durante a gestação. Trata-se de uma revisão integrativa de literatura embasada pela análise de 2.441 artigos no total, dos quais 62 foram incluídos na pesquisa, sendo 38 deles da base de dados PubMed e 24 da BVS (Biblioteca Virtual em Saúde), nos idiomas inglês e português. Em conclusão, mulheres grávidas com diagnóstico da patologia podem precisar de assistência de alta complexidade. A associação à doença pode apresentar riscos ou complicações como coagulopatias, pré-eclâmpsia, prematuridade e outros desfechos negativos que serão abordados neste artigo.(AU)

SARS-CoV-2 is an RNA virus, transmitted by direct or indirect contact by infected droplets. Regarding to COVID-19 and pregnancy, references indicate that during this period, women are more susceptible to obstetric and perinatal complications. This study aims to understand and compile aspects of infection and the main negative maternal and fetal outcomes documented in the current literature, related to the infection by the new coronavirus during pregnancy. This is an integrative literature review based on the analysis of 2,441 articles in total, of which 62 were included in the survey, 38 from the PubMed database and 24 from BVS (Biblioteca Virtual em Saúde) in English and Portuguese languages. In conclusion, pregnant women diagnosed with the pathology may need highly complex assistance. The association with the disease may present risks for complications such as coagulopathies, pre-eclampsia, prematurity and other negative outcomes that will be addressed in this article.(AU)

Rickettsia conorii infection with fatal complication

ABSTRACT Rickettsial diseases (RD) are a group of endotheliotropic infectious diseases caused by different species of genera Rickettsia. RD are not an uncommon disease and may be misdiagnosed during the evaluation of acute febrile illness due to a lack of reliable serological marker and diagnostic culture methods. Clinical manifestation of RD varies from febrile illness with rashes and myalgia to fatal complications such as shock and respiratory failure. We describe a case of a young male who presented initially with acute febrile illness, followed by shock and respiratory failure, and unfortunately succumbed to death. A post-mortem examination showed histological features of endotheliotropic infection, such as interstitial / perivascular edema in various organs and noncardiogenic pulmonary edema (suggesting increased vascular permeability) and evidence of vasculitis in the lung, liver, and intestines. Molecular studies performed from lung, liver, and kidney tissue confirm the diagnosis of spotted fever group rickettsial disease due to Rickettsia conorii.

Preocupação e medo como preditores de fatalismo por COVID-19 no cotidiano de trabalho dos enfermeiros / Worry and fear as predictors of fatalism by COVID-19 in the daily work of nurses / Preocupación y miedo como predictores de fatalismo por COVID-19 en lo cotidiano laboral de enfermeros

Resumo Objetivo: analisar a relação entre a preocupação e o medo da COVID-19 com o fatalismo no cotidiano de trabalho dos enfermeiros. Método: estudo transversal analítico, realizado com 449 enfermeiros. A coleta de dados foi realizada por meio de instrumentos validados no Peru. Na análise, foram utilizados o teste de Shapiro-Wilk e o coeficiente de correlação de Spearman, sendo estimados dois modelos de regressão múltipla, com seleção de variáveis por etapas. Resultados: os enfermeiros apresentaram nível moderado de fatalismo e baixo nível de medo e preocupação com a COVID-19. O primeiro modelo estatístico, que incluiu variáveis sociodemográficas, explica apenas 3% da variância de fatalismo. No entanto, um segundo modelo que inclui medo e percepção explica 33%. Conclusão: a preocupação, o medo e ter sido diagnosticado com COVID-19 foram fatores preditores de fatalismo. Sugere-se a implementação de intervenções psicoemocionais no cotidiano de trabalho, voltadas para profissionais de Enfermagem que apresentem altos níveis de medo ou preocupação, para reduzir o fatalismo e, assim, prevenir consequências fatais da pandemia e promover a saúde.

Abstract Objective: to analyze the relationship between the concern and fear of COVID-19 with fatalism in the daily work of nurses. Method: analytical cross-sectional study carried out with a total of 449 nurses. Data collection was performed using instruments validated in Peru. In the analysis, the Shapiro-Wilk test and the Spearman correlation coefficient were used, and two multiple regression models were estimated, with variable selection in stages. Results: nurses had a moderate level of fatalism and a low level of fear and concern about COVID-19. The first statistical model, which included sociodemographic variables, explains only 3% of the fatalism variance. However, a second model that includes fear and perception explains 33% of it. Conclusion: Worry, fear and having been diagnosed with COVID-19 were predictors of fatalism. It is suggested the implementation of psycho-emotional interventions in daily work - aimed at Nursing professionals who present high levels of fear or concern - to reduce fatalism and prevent fatal consequences of the pandemic and promote health.

Resumen Objetivo: analizar la relación entre la preocupación y el miedo al COVID-19 con el fatalismo, en lo cotidiano laboral de los enfermeros. Método: estudio transversal tipo analítico, realizado en 449 enfermeros. La recolección de datos se realizó mediante instrumentos validados en Perú. En el análisis se utilizó la prueba de Shapiro-Wilk, el coeficiente de correlación de Spearman y se estimaron dos modelos de regresión múltiple, con selección de variables por pasos. Resultados: los enfermeros presentaron un nivel moderado de fatalismo y un nivel bajo de miedo y preocupación por la COVID-19. El primer modelo estadístico que incluyó las variables sociodemográficas apenas explica un 3% de la varianza de fatalismo; sin embargo, un segundo modelo que incluye el miedo y la percepción explica el 33%. Conclusión: la preocupación, el miedo y el haber sido diagnosticado con COVID-19 fueron factores predictores de fatalismo. Se sugiere implementar intervenciones psicoemocionales en el cotidiano laboral - focalizadas en profesionales de Enfermería que presenten altos niveles de miedo o preocupación - para reducir el fatalismo y de esta manera prevenir consecuencias fatales de la pandemia y promover la salud.

High mortality among patients with cancer and COVID-19 infection: the experience of a Brazilian cancer center / Alta mortalidade entre pacientes com câncer e infecção por COVID-19: a experiência de um centro oncológico brasileiro

ABSTRACT Objective To evaluate the severity of COVID-19 in cancer patients to describe clinical and epidemiological factors associated with poor outcomes (mortality and need of intensive care unit admission or mechanical ventilation). Methods Retrospective data from patients with cancer and laboratory diagnosis of COVID-19, obtained between March 16 and May 29, 2020, were retrieved out of a cancer center database. Data analyzed included patient history, age, sex, comorbidities, types of cancer and anticancer therapy. Results This sample comprised 105 patients aged 18-92 years, 80.9% of whom were females. Dyspnea was the most prevalent initial symptom (30.4%) among patients who died (p<0.0001). Overall, 57.1% of patients had metastatic disease and 60% had poor performance status (Eastern Cooperative Oncologic Group ≥2) at the time of COVID-19 diagnosis. The overall mortality rate was 40.95%. Mortality rates were higher in male patients and those with poor performance status (p<0.0001). Conclusion This cohort is one of the largest Brazilian studies describing clinical and epidemiological features of patients with cancer and concurrent COVID-19. Findings of this study emphasize the vulnerability of cancer patients in the current pandemic, and indicate high mortality from COVID-19 among male cancer patients and cancer patients with poor performance status. This analysis may assist the selection of patients who may benefit from strict isolation and eventual discontinuation of anticancer therapy to reduce exposure to infection.

RESUMO Objetivo Avaliar a gravidade da infecção por COVID-19 em pacientes oncológicos, determinando os aspectos clínicos e epidemiológicos associados ao pior desfecho, seja em termos de mortalidade, necessidade de internação em unidade de terapia intensiva ou ventilação mecânica. Métodos Pacientes com câncer e diagnóstico confirmado por laboratório de COVID-19 foram identificados nos bancos de dados de um hospital oncológico entre 16 de março e 29 de maio de 2020. Os dados coletados incluíram história, idade, sexo e comorbidades dos pacientes, além dos tipos de câncer e do tratamento anticâncer. Resultados Dentre os 105 pacientes analisados, a idade variou de 18 a 92 anos, e 80,9% eram do sexo feminino. Dispneia foi o sintoma inicial mais prevalente entre os que morreram (30,4%). No momento do diagnóstico da infecção, 57,1% apresentavam doença metastática e 60% performance status ruim (Eastern Cooperative Oncologic Group ≥2). A taxa de mortalidade geral foi 40,95% e superior entre os homens e pacientes com baixo nível de performance status (p<0,0001). Conclusão Este coorte é um dos estudos mais robustos do Brasil, descrevendo características clínicas e epidemiológicas de pacientes com câncer e COVID-19. Os achados do estudo alertam para a vulnerabilidade dos pacientes oncológicos na pandemia atual e demonstram alta mortalidade por COVID-19 em pacientes do sexo masculino e com pior performance status. Essa análise pode ajudar a selecionar os pacientes que podem se beneficiar de isolamento rigoroso e até mesmo da interrupção do tratamento, reduzindo a exposição à infecção.

Síndrome de encefalopatía posterior reversible secundario a trastornos hipertensivos del embarazo. Serie de casos / Posterior reversible encephalopathy syndrome secondary to hypertensive disorders of pregnancy. Case series

Resumen OBJETIVO: Describir las características clínicas e imagenológicas de pacientes con encefalopatía posterior reversible atendidas en una unidad de cuidados intensivos. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo y transversal de serie de casos efectuado en pacientes con diagnóstico de encefalopatía posterior reversible secundaria a trastornos hipertensivos atendidas en la unidad de cuidados intensivos del Hospital Universitario de la Samaritana, Bogotá, Colombia, entre el 1 de enero de 2013 y el 31 de diciembre de 2020. RESULTADOS: Se encontraron 12 pacientes con encefalopatía posterior reversible; 8 de ellas con inicio durante el puerperio inmediato y 4 en el puerperio mediato. Se diagnosticó eclampsia en 6 pacientes durante el embarazo y en 5 durante el posparto. Los síntomas más comunes fueron: cefalea y convulsiones. Los hallazgos imagenológicos mostraron edema con mayor frecuencia en los lóbulos posteriores del cerebro; sobre todo en el occipital bilateral y parietooccipital. Todas las pacientes fueron dadas de alta del hospital sin lesiones neurológicas irreversibles. CONCLUSIONES: La encefalopatía posterior reversible es poco común pero debe considerarse en las pacientes con síntomas neurológicos concomitantes con los trastornos hipertensivos del embarazo. Si bien la muestra es de pocos casos, sí puede mencionarse que el diagnóstico radiológico con resonancia magnética cerebral, el tratamiento oportuno y las intervenciones multidisciplinarias disminuyen el riesgo de lesiones neurológicas irreversibles y el desenlace fatal.

Abstract OBJECTIVE: To describe the clinical and imaging characteristics of patients with posterior reversible encephalopathy seen in an intensive care unit. MATERIALS AND METHODS: Retrospective, descriptive, cross-sectional case series study performed in patients with a diagnosis of reversible posterior encephalopathy secondary to hypertensive disorders attended in the intensive care unit of the Hospital Universitario de la Samaritana, Bogotá, Colombia, between January 1, 2013 and December 31, 2020. RESULTS: We found 12 patients with reversible posterior encephalopathy; 8 of them with onset during the immediate puerperium and 4 in the mediate puerperium. Eclampsia was diagnosed in 6 patients during pregnancy and in 5 during the postpartum period. The most common symptoms were headache and convulsions. Imaging findings showed edema most frequently in the posterior lobes of the brain, especially in the bilateral occipital and parietooccipital lobes. All patients were discharged from the hospital without irreversible neurological lesions. CONCLUSIONS: Reversible posterior encephalopathy is uncommon but should be considered in patients with neurologic symptoms concomitant with hypertensive disorders of pregnancy. Although the sample is small, it can be mentioned that radiological diagnosis with brain magnetic resonance imaging, timely treatment and multidisciplinary interventions decrease the risk of irreversible neurological lesions and fatal outcome.

Valor prognóstico das concentrações precoces de metaloproteinases -2 e -9 após traumatismo craniencefálico grave / Prognostic utility of early plasma matrix metalloproteinases -2 and -9 concentrations after severe traumatic brain injury

RESUMO Objetivo: Determinar se os níveis plasmáticos das metaloproteinases de matriz -2 e -9 tem associação com a mortalidade na unidade de terapia intensiva em pacientes com trauma craniencefálico grave, independentemente de lesões não cerebrais associadas. Métodos: Esta coorte prospectiva incluiu 39 pacientes do sexo masculino com trauma craniencefálico grave (escore na escala de coma Glasgow na admissão hospitalar: 3 - 8). Os níveis plasmáticos das metaloproteinases -2 e -9 foram determinados por ELISA no momento da admissão na unidade de terapia intensiva. Resultados: O trauma craniencefálico grave apresentou mortalidade de 46% na unidade de terapia intensiva. Concentrações mais elevadas de metaloproteinase -9 apresentaram associação com a mortalidade: 147,94 ± 18,00ng/mL para pacientes que sobreviveram e 224,23 ± 23,86ng/mL para os que não sobreviveram (média ± erro padrão, respectivamente; p = 0,022). Todavia, não houve associação significativa entre os níveis de metaloproteinase -2 e a mortalidade na unidade de terapia intensiva: 315,68 ± 22,90ng/mL para o grupo de sobreviventes e 336,55 ± 24,29ng/mL entre os pacientes que não sobreviveram (p = 0,499). Além disso, não se observaram associações significativas entre os níveis de metaloproteinase -2 (p = 0,711) ou metaloproteinase -9 (p = 0,092) e a presença de lesões não cerebrais associadas. Conclusão: Em vítimas de traumatismo craniencefálico grave, níveis elevados de metaloproteinase -9 tiveram valor preditivo para o desfecho fatal na unidade de terapia intensiva independentemente da presença de lesões não cerebrais associadas. Por outro lado, no mesmo cenário, os níveis plasmáticos de metaloproteinase -2 não apresentaram associação com a mortalidade na unidade de terapia intensiva

Abstract Objective: To determine whether the matrix metalloproteinases-2 and -9 plasma levels were associated with intensive care unit mortality in patients who suffered severe traumatic brain injury, despite the presence of extracerebral injuries. Methods: This prospective cohort enrolled 39 male patients who suffered severe traumatic brain injury (Glasgow coma scale: 3 - 8 at hospital admission). The plasma matrix metalloproteinase -2 and matix metalloproteinase -9 levels were determined by ELISA at the time of intensive care unit admission. Results: Severe traumatic brain injury was associated with a 46% intensive care unit mortality rate. Higher plasma matrix metalloproteinase -9 concentrations were associated with mortality: 147.94 ± 18.00ng/mL for survivors and 224.23 ± 23.86ng/mL for nonsurvivors (mean ± standard error of the mean, p = 0.022). In contrast, there was no significant association between matrix metalloproteinase -2 levels and intensive care unit mortality: 315.68 ± 22.90ng/mL for survivors and 336.55 ± 24.29ng/mL for nonsurvivors (p = 0.499). Additionally, there were no significant associations between matrix metalloproteinase -2 (p = 0.711) and matrix metalloproteinase -9 (p = 0.092) levels and the presence of associated lesions. Conclusion: Increased plasma matrix metalloproteinase -9 levels were associated with intensive care unit mortality following severe traumatic brain injury, regardless of the presence of extracerebral injuries. Conversely, in this same context, plasma matrix metalloproteinase -2 levels were not associated with short-term fatal outcome prediction.

Fatalismo ante la posibilidad de contagio por el coronavirus: Generación y validación de un instrumento (F-COVID-19) / Fatalism due to the possibility of coronavirus infection: Generation and validation of an instrument (F-COVID-19)

El coronavirus ha generado una suerte de "histeria colectiva" en diversas poblaciones. Por lo tanto, nuestro objetivo fue validar un test que mida el fatalismo ante la posibilidad de contagio por el coronavirus. Se realizó un proceso de validación en cinco fases: Búsqueda de la literatura y construcción del primer borrador, juicio de fondo con 28 expertos, evaluación de forma con 280 personas, piloto para análisis factorial exploratorio en 389 personas (en ambas se contó con 17 ciudades de Perú) y confirmación de la validez del constructo final con 10 expertos. Los estadísticos de KMO (0,779) y Bartlett (572,6; gl = 21; p < 0,001) presentaron resultados aceptables y significativos. La varianza total explicada por los 7 ítems distribuidos en 2 factores es de 58,9%, lo cual es adecuado. Los análisis robustos muestran que la estructura factorial es satisfactoria (X2 = 21,161; p = 0,007; CFI = 0,984; GFI = 0,996; TLI = 0,957; RMSEA = 0,067 y RMSR = 0,033). Se generó una escala de 7 ítems para medir las medidas fatalistas que las personas podrían tener o tomar si es que llegasen a enfermarse del coronavirus

Coronavirus has generated a kind of "mass hysteria" in various populations. A validation process was generated for a test that measures fatalism in the face of the possibility of infection by the coronavirus. A validation process was carried out in five phases: literature search and construction of the first draft, substantive judgement with 28 experts, formal evaluation with 280 people, pilot for exploratory factor analysis in 389 people (in both cases there were 17 cities in Peru) and confirmation of the validity of the final construct with 10 experts. The statisticians of KMO (0.779) and Bartlett (572.6; gl = 21; p < 0.001) presented acceptable and significant results. The total variance explained by the 7 items distributed in 2 factors is 58.9%, which is adequate. Robust analyses show that the factor structure is satisfactory (X2 = 21.161; p = 0.007; IFC = 0.984; GFI = 0.996; TLI = 0.957; RMSEA = 0.067 and RMSR = 0.033). A 7-item scale was generated to measure the fatalistic measures people might have or take if they became ill with the coronavirus

Hepatocarcinoma fibrolamelar. Presentación de un caso clínico / Fibrolamellar hepatocarcinoma. Presentation of a clinical case / Hepatocarcinoma fibrolamelar. Relato de um caso clínico

Resumen: El hepatocarcinoma fibrolamelar es una entidad poco frecuente cuya incidencia varía entre 1% y 5% en el porcentaje de todos los hepatocarcinomas. Afecta principalmente a pacientes jóvenes con hígado sano, y en el 50% de los casos su diagnóstico se realiza en etapas avanzadas de la enfermedad. Se presenta el caso de un paciente de 15 años de edad, sano, que consulta por tumoración abdominal de tres meses de evolución, dolor en epigastrio y adelgazamiento. Los estudios de imagen informan tumoración que sustituye el lóbulo izquierdo del hígado con realce heterogéneo en la fase arterial, que infiltra la vena suprahepática izquierda. Además, informa lesiones en los segmentos V y VIII, extensas adenopatías en el hilio hepático, y nódulos a nivel peritoneal y subpleural. Se realizó punción biópsica hepática que confirmó el diagnóstico de hepatocarcinoma fibrolamelar, iniciándose tratamiento oncoespecífico.

Summary: Fibrolamellar hepatocellular carcinoma is a rare entity that represent between 1% to 5% of all hepatocarcinomas. Tipically affects younger patients (10 to 30 year of age) of both sexes, without underlying liver disease. In 50% of the cases the diagnosis is made in advanced stages of the disease. We present the case of a male patient of 15 years of age, healthy, who consulted due to an abdominal tumor of 3 months evolution, epigastric pain and weight loss. The imaging studies report a tumor that replaces the left lobe with heterogeneous enhancement in the arterial phase that infiltrates the left suprahepatic vein. Injuries in segment V and VIII. Extensive lymphadenopathy in the liver liver. Peritoneal and subpleural nodule. Hepatic biopsy puncture was performed confirming fibrolaminar hepatocarcinoma. Start once specific treatment.

Resumo: Entidade pouco frequente cuja incidência varia entre 1% e 5% de todos os hepatocarcinomas. Acomete principalmente pacientes jovens com fígado saudável e em quase 50% dos casos o diagnóstico é feito em estágios avançados da doença. Apresentamos o caso de um paciente do sexo masculino, de 15 anos de idade, saudável, que consultou devido a um tumor abdominal de 3 meses de evolução, dor epigástrica e perda de peso. Os estudos de imagem relatam um tumor que substitui o lobo esquerdo com realce heterogêneo na fase arterial que infiltra a veia supra-hepática esquerda. Lesões do segmento V e VIII. Linfadenopatia extensa no fígado do fígado. Nódulo peritoneal e subpleural. A punção da biópsia hepática foi realizada confirmando o hepatocarcinoma fibrolaminar. Iniciar um tratamento específico.

A brief-review of the risk factors for covid-19 severity

ABSTRACT The World Health Organization has emphasized that one of the most important questions to address regarding the covid-19 pandemic is to understand risk factors for disease severity. We conducted a brief review that synthesizes the available evidence and provides a judgment on the consistency of the association between risk factors and a composite end-point of severe-fatal covid-19. Additionally, we also conducted a comparability analysis of risk factors across 17 studies. We found evidence supporting a total of 60 predictors for disease severity, of which seven were deemed of high consistency, 40 of medium and 13 of low. Among the factors with high consistency of association, we found age, C-reactive protein, D-dimer, albumin, body temperature, SOFA score and diabetes. The results suggest that diabetes might be the most consistent comorbidity predicting disease severity and that future research should carefully consider the comparability of reporting cases, factors, and outcomes along the different stages of the natural history of covid-19.

Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital / La infección respiratoria aguda grave asociada a la gripe en pacientes adultos en Chile: experiencia de un hospital centinela / Infecção respiratória aguda grave (SARI) decorrente da influenza em pacientes adultos no Chile: experiência de um hospital-sentinela

ABSTRACT Objective To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet). Methods Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. Results A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn-winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0-164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44-55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02-33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20-24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021-0.90). Conclusions Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.

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RESUMO Objetivo Descrever as características clínicas de pacientes adultos com infecção respiratória aguda grave (SARI) associada ao vírus da influenza e analisar os subtipos virais identificados em amostras coletadas destes pacientes, os recursos hospitalares empregados no tratamento clínico, a evolução clínica e os fatores de risco clínicos associados a um desfecho fatal, a partir de dados observacionais da rede de vigilância de SARI (SARInet) no Chile. Métodos Foram identificados os adultos hospitalizados com SARI associada a influenza em um hospital-sentinela de vigilância de SARI, em Santiago, de 1o de julho de 2011 a 31 de dezembro de 2015. A ocorrência de influenza foi confirmada em amostras respiratórias em todos os casos com a reação em cadeia da polimerase via transcriptase reversa (RT-RCP). Resultados Ao todo, 221 pacientes (idade média de 74,1 anos) foram hospitalizados com SARI associada a influenza no período de estudo. Nesta coorte, 91,4% apresentavam fatores de risco para complicação e 34,3% haviam sido vacinados na última campanha de vacinação. Pneumonia foi a manifestação clínica mais frequente, ocorrendo em 57,0% da coorte. Outras manifestações foram doença gripal, bronquite crônica exacerbada, insuficiência cardíaca descompensada e crise asmática. Os casos estiveram distribuídos ao longo do ano, com pico epidêmico no outono-inverno. Houve circulação simultânea dos vírus da influenza A (H1N1pdm09 e H3N2) e B. Leitos de terapia intensiva foram necessários em 26,7% da coorte e suporte ventilatório, em 19,5%. Na análise multivariada, quatro fatores importantes associados à mortalidade hospitalar foram identificados: estar restrito ao leito (odds ratio ajustado [ORaj] 22.3; intervalo de confiança de 95% [IC 95%] 3.0-164); ser admitido na unidade de terapia intensiva (ORaj 8.9, IC 95% 1.4 4-55); relação Pa02/Fi02 <250 (ORaj 5.8; IC 95% 1.02-33) e aumento da creatinina sérica (>1 mg/dl) (ORaj 5.47; IC 95% 1.20-24). A vacinação sazonal contra influenza foi identificada como importante fator de proteção (ORaj 0.14; IC 95% 0.021-0.90). Conclusões A SARI associada a influenza acometeu sobretudo pacientes idosos com doenças preexistentes. A maioria dos pacientes evoluiu com insuficiência respiratória e mais de um quarto precisou de cuidados intensivos. O quadro clínico foi variável. Morte foi associada às características do hospedeiro e problemas relacionados à doença. A vacinação teve efeito protetor e o tipo viral não influiu no desfecho.

Años potenciales de vida perdidos por incidentes viales de motociclistas, Medellín, 20092012: un analisis espacial por sitio de la ocurrencia / Potential years of life lost due to road incidents of motorcyclists, Medellin, 2009-2012: a spatial analysis of the occurrencesite

Introducción. La accidentalidad de motociclistas es una problemática de salud pública de Medellín, que afecta inequitativamente a la población. Objetivo. Describir los años potenciales de vida perdidos (APVP) por accidentes de motociclistas en Medellín entre 2009 y 2012. Métodos. Se realizó un estudio descriptivo con fuente de información secundaria ajustada con el método de Preston y Coale, y OPS de distribución proporcional; en el cálculo de los APVP se empleó como valor de referencia la proyección anual de la esperanza de vida al nacer de Colombia 2009-2014 y para el análisis geográfico se empleó el método cuantil de clasificación, la densidad de Kernel y la simbología por cantidades y atributos múltiples. Resultados. El 79,4% de los muertos en incidentes viales fueron hombres, el 50% tenía 40 años o menos (RQ= 35 años); los peatones (45,6%) y los motociclistas (31,7%) fueron los usuarios más vulnerables de la vía. Los motociclistas hombres entre los 15 y 29 años tuvieron la mayor pérdida de años potenciales de vida, al igual que los accidentados en los barrios Caribe, San Cristóbal, Guayabal y Castilla; la mayor frecuencia de motociclistas muertos se observó en tramos de la autopista norte, la autopista sur, la carrera 65, la avenida regional y la avenida guayabal. Conclusión. En Medellín los motociclistas jóvenes de sexo masculino presentan las tasas de APVP más altas del periodo, lo que implica mayores costos sociales y económicos para la ciudad. La accidentalidad fatal más alta de este grupo de interés se presenta en las vías principales de la ciudad aledañas al río Medellín

Introduction. Motorcycle accidents is a public health problem of Medellin, which affects unfairly the population. Objective. To describe the potential years of life lost (YPLL) motorcycle accident in Medellin between 2009 and 2012. Methods: A descriptive study was conducted with secondary information source adjusted with the Preston and Coale method; in the calculation of YPLL, the annual projection of life expectancy at birth of Colombia 2009-2014 was used as reference value, and for the geographic analysis the “Quantile” classification method, Kernel density and symbology amounts and multiple attributes were used. Results: 79.4% of those killed in road accidents were men, 50% were 40 years old or less; pedestrians (45.6%) and motorcyclists (31.7%) were the most vulnerable road users. Motorcyclists men between 15 and 29 years of age had the highest amount of potential years of life lost, in the same way, the road accidents in Caribe, San Cristóbal, Guayabal and Castilla neighborhoods; the increased frequency of motorcyclists killed was observed in sections of the highway north, the south highway, running 65 regional and Guayabal Avenue. Conclusion: In Medellin young male motorcyclists have YPLL rates highest in the period, which implies greater social and economic costs for the city. The highest fatal accident rate of this interest group is presented on the main roads of the city along the Medellin River

A fatal case of acute bentazone overdose despite cricothyroidotomy during cardiopulmonary resuscitation

Bentazone is classified as a moderately hazardous (class II) herbicide by the World Health Organization. A 53-year-old Korean woman was transferred to the emergency department after a suicide attempt using approximately 500 mL of bentazone one hour prior to admission. Upon admission, she was alert and tachycardia of 125/min was observed. She was treated with gastric lavage and activated charcoal, during which she experienced diarrhea. Two hours after bentazone ingestion, cardiac arrest and muscle rigidity throughout the body occurred. Cardiopulmonary resuscitation was immediately started. Endotracheal intubation after administration of a muscle relaxant (succinylcholine) was unsuccessful because of temporomandibular joint muscle rigidity. Surgical cricothyroidotomy was performed by the emergency physician, but the patient was not resuscitated. For cardiac arrest patients with muscle rigidity caused by bentazone overdose, endotracheal intubation may be challenging because of muscle rigidity, despite appropriate use of muscle relaxants. Early surgical cricothyroidotomy may be the preferred method of airway management in these patients.

Crônica de uma morte adiada: o tabu da morte e os limites não científicos da ciência / A chronicle of a death delayed: the taboo of death and the non-scientific limits of science / Crónica de uma muerte anunciada: el tabú de la muerte y los límites no científicos de la ciencia

Este relato, apresentado como estudo de caso, acompanha os oito dias que transcorreram entre a internação para a implantação de um marca-passo e o falecimento de um sujeito de 92 anos, com histórico de hipertensão, diabetes melito e em estágio avançado de Alzheimer, caracterizado por completa perda das memórias de longo e curto prazos e por quadro geral de demência, com total incapacidade de compreensão de sua situação no contexto hospitalar. Trata-se de relato de caráter subjetivo, realizado por um observador com vínculos afetivos com o sujeito objeto da observação e com atuação acadêmica em área estranha à medicina.

This report, presented as a case study, follows the eight days between internment for implantation of a pacemaker and the passing of a 92 year old person, with a history of hypertension and diabetes mellitus and at an advanced stage of Alzheimer's disease, characterized by complete loss of long and short term memory and an overall diagnosis of dementia with total incapacity for comprehension of his or her own hospital context. This is a report from the viewpoint of an observer with affective ties to the focus subject and with academic activities outside the area of medicine.

Este relato, presentado como estudio de caso, acompaña los ocho días que transcurrieron entre la internación para la implantación de un marcapasos y el fallecimiento de un sujeto de noventa y dos años, con un historial de hipertensión, diabetes mellitus y un estadio avanzado de Alzheimer, caracterizado por una completa pérdida de memoria de largo y corto plazo y por un cuadro general de demencia con total incapacidad de comprensión de su situación en el contexto hospitalario. Se trata de un relato realizado a partir del punto de vista subjetivo de un observador con vínculos afectivos con el sujeto objeto de observación y con una actuación académica en un área ajena a la Medicina.

The long-term outcome after acute kidney injury: a narrative review / Evolução em longo prazo após episódio de lesão renal aguda: revisão narrativa

This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.

Esta revisão tem como objetivo focar o prognóstico em longo prazo de pacientes após episódio de lesão renal aguda (LRA). Pacientes sobreviventes à LRA apresentam maior mortalidade tardia quando comparados com aqueles internados sem LRA. Estudos recentes mostram mortalidade em logo prazo após LRA entre 15 e 74% e, de modo geral, são fatores que contribuem para essa mortalidade a idade avançada, a presença de comorbidades preexistentes e a recuperação incompleta da função renal. LRA também está associada com evolução para doença renal crônica, sendo a queda de função renal na alta hospitalar e número e intensidade dos episódios de LRA fatores associados com a evolução para DRC. A recuperação da função renal é definida pela maioria dos estudos como a não dependência de diálise e ocorre em 60 a 70% dos pacientes em até 90 dias. Futuros estudos são necessários para explorar o prognóstico tardio desses pacientes.

Prognostic value of NIHSS and MRI-PC-ASPECTS in patients with posterior circulation ischemic stroke / 实用医学杂志

Objective To investigate the value of modified NIHSS and MRI-PC-ASPECTS for the long-term prognosis in posterior circulation ischemic stroke. Methods Seventy eight patients with posterior circulation ischemic stroke were divided into two groups depended on MRS: good outcome group and bad outcome group. General information of patients was collected and vascular risk factors, NIHSS, MRI-PC-ASPECTS of the two groups were compared. Results The scores of admission NIHSS and highest NIHSS of bad outcome group were higher than that of good outcome group. The scores of MRI-PC-ASPECTS, T admission NIHSS (42-admission NIHSS) and T highest NIHSS of bad outcome group were lower than that of good outcome group (P<0.05). The areas under the ROC curves of MRI-PC-ASPECTS+T highest NIHSS, MRI-PC-ASPECTS, T highest NIHSS and T admission NIHSS were 0.907, 0.821, 0.870, 0.744, respectively (P<0.05). Conclusion NIHSS and MRI-PC-ASPECTS can predict the functional prognosis in patients with posterior circulation ischemic stroke.