Clinical significance of early troponin I levels on the prognosis of patients with severe heat stroke / 中华危重病急救医学

OBJECTIVE@#To investigate the clinical significance of early troponin I (TnI) level in the prognosis of severe heat stroke.@*METHODS@#Clinical data of 131 patients with severe heat stroke in the intensive care unit (ICU) of the Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University (study dataset) and ICU 67 patients with severe heat stroke in Jintan First People's Hospital of Changzhou (validation dataset) were retrospectively analyzed from June 2013 to September 2022. The patients were divided into survival group and death group according to 30-day outcomes. TnI was collected within 24 hours after admission to the emergency department. Cox regression analysis was performed to analyze the risk factors of severe heat stroke death. Spearman correlation test was used to analyze the correlation between TnI and heart rate, and peripheral systolic blood pressure. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of TnI for death in patients with severe heat stroke. Decision curve analysis (DCA) was conducted to assess the clinical net benefit rate of TnI prediction. Grouping by TnI cut-off value, Kaplan-Meier survival curve was used to analyze 30-day cumulative survival. Sensitivity analysis included modified Possion regression, E-value, and subgroup forest map was used to evaluate the mortality risk of TnI in different populations. External dataset was used to verify the predictive value of TnI.@*RESULTS@#The death group had significantly higher TnI compared to the survival group [μg/L: 0.623 (0.196, 1.510) vs. 0.084 (0.019, 0.285), P < 0.01]. Multivariate Cox regression analysis after adjusting for confounding factors showed that TnI was an independent risk factor for death [hazard ratio (HR) = 1.885, 95% confidence interval (95%CI) was 1.528-2.325,P < 0.001]. Spearman correlation test showed that TnI was positively correlated with heart rate (r = 0.537, P < 0.001) and negatively correlated with peripheral systolic blood pressure (r = -0.611, P < 0.001). ROC curve showed that the area under the curve (AUC) of the TnI (0.817) was better than that of the acute physiology and chronic health evaluation II (APACHE II, 0.756). The DCA curve showed that the range of clinical net benefit rate of TnI (6.21%-20.00%) was higher than that of APACHE II score (5.14%-20.00%). Kaplan-Meier survival curve showed that patients in the low-risk group (TnI ≤ 0.106) had a significantly higher 30-day survival rate than that in the high-risk group (TnI > 0.106) group (Log-Rank test: χ2 = 17.350, P < 0.001). Modified Possion regression with adjustment for confounding factors showed that TnI was still an independent risk factor for death in patients with severe heat stroke [relative risk (RR) = 1.425, 95%CI was 1.284-1.583, P < 0.001]. The E-value was 2.215. The subgroup forest plot showed that the risk factors of TnI were obvious in male patients and patients ≤ 60 years old (male: HR = 1.731, 95%CI was 1.402-2.138, P < 0.001; ≤ 60 years old: HR = 1.651, 95%CI was 1.362-2.012, P < 0.001). In the validation dataset, ROC curve analysis showed that the AUC (0.836) of TnI predicting the prognosis of severe heat stroke was still higher than the APACHE II score (0.763).@*CONCLUSIONS@#Early elevation of TnI is a high-risk factor for death in patients with severe heat stroke, and it has a good predictive value for death.

Manifestaciones clínicas, diagnóstico y tratamiento del golpe de calor / Clinical Manifestations, Diagnosis and Management of Heat Stroke

Introducción: El golpe de calor es una enfermedad que fue descrita hace más de 2000 años, sin embargo, los cambios climáticos que se han presentado en las últimas décadas han permitido que su prevalencia esté en aumento. Se considera una entidad compleja en la cual existe un compromiso importante de la termorregulación corporal y, en consecuencia, del resto de sistemas. Objetivos: Orientar al abordaje adecuado y óptimo de conceptos clínicos, epidemiológicos, factores el riesgo, presentación clínica y repercusión sobre los diferentes sistemas. Métodos: Se realizó una revisión de la literatura científica de personas con golpe de calor, en quienes se evaluaron sus factores asociados, métodos diagnósticos y manejos terapéuticos. Se realizó una búsqueda de la literatura en las siguientes bases de datos: Pubmed/Medline, Science Direct, Scopus, DOAJ, Embase, Cochrane, Direme, Redalyc y SciELO. Conclusiones: El golpe de calor es una urgencia médica que implica un manejo rápido y óptimo dado su morbilidad y mortalidad, lo cual puede minimizarse si se cumplen los objetivos de tratamiento. El enfriamiento por inmersión en agua helada, por convección o evaporación son las medias más usadas. Evitar la falla multiorgánica es el segundo objetivo terapéutico(AU)

Introduction: Heat stroke is a disease described more than 2000 years ago; however, the climatic changes that have occurred in recent decades have allowed an increase in its prevalence. It is considered a complex entity in which there is an important compromise of body thermoregulation and, consequently, of the rest of the systems. Objectives: To define important concepts concerning heat stroke, risk factors, clinical presentation and repercussions on the different systems, as well as to guide an appropriate and optimal management. Methods: A review of the scientific literature about people with heat stroke was carried out to assess its associated factors, diagnostic methods and therapeutic management. A literature search was performed in the following databases: Pubmed/Medline, Science Direct, Scopus, DOAJ, Embase, Cochrane, Bireme, Redalyc, and SciELO. Conclusions: Heat stroke is a medical emergency that requires rapid and optimal management given its morbidity and mortality, which can be minimized if management goals are met. Cooling by immersion into ice water, convection or evaporation are the most commonly used measures. Avoidance of multiorgan failure is the second therapeutic objective(AU)

Heat stroke during long-term clozapine treatment: should we be concerned about hot weather? / Heat stroke durante tratamento de longo prazo com clozapina: devemos nos preocupar com o tempo quente?

Objective To describe the case of a patient with schizophrenia on clozapine treatment who had an episode of heat stroke. Case description During a heat wave in January and February 2014, a patient with schizophrenia who was on treatment with clozapine was initially referred for differential diagnose between systemic infection and neuroleptic malignant syndrome, but was finally diagnosed with heat stroke and treated with control of body temperature and hydration. Comments This report aims to alert clinicians take this condition into consideration among other differential diagnoses, especially nowadays with the rise in global temperatures, and to highlight the need for accurate diagnosis of clinical events during pharmacological intervention, in order to improve treatment decisions and outcomes.

Objetivo Descrever o caso de um paciente com esquizofrenia em tratamento com clozapina acometido por um episódio de heat stroke. Descrição do caso Durante uma onda de calor em janeiro e fevereiro de 2014, um paciente com esquizofrenia em tratamento com clozapina foi inicialmente encaminhado para diagnóstico diferencial de infecção sistêmica e síndrome neuroléptica maligna, tendo obtido o diagnóstico final de heat stroke, tratado com controle de temperatura corporal e hidratação. Comentários Este relato de caso tem como objetivo alertar os clínicos para este diagnóstico diferencial, que pode surgir com mais frequência à medida que as temperaturas globais continuarem a aumentar, e também destacar a importância da realização de um diagnóstico mais acurado, que possa melhorar as decisões de tratamento e os desfechos clínicos para os pacientes.

Golpe de calor: a propósito de un caso clínico / Heat stroke. a case report

El golpe de calor es una entidad poco frecuente y subdiagnosticada. La elevación de la temperatura corporal es la que desencadena las disfunciones metabólicas que pueden incluso llevar a la muerte. Se presenta el caso de un militar que se encontraba realizando ejercicios de infantería, durante el mes de septiembre, en días donde se produjeron condiciones climáticas extremas y desarrolla un cuadro de Disfunción Orgánica Múltiple (DOM) primaria; fue llevado al Servicio de Emergencia del Hospital de Fray Bentos, Río Negro. La evolución inicial se caracterizó por deterioro de la función neurológica, respiratoria, necesidad de ventilación mecánica, falla renal aguda y disfunción hematológica; se establecieron los diagnósticos de golpe de calor, injuria renal, rabomiólisis, insuficiencia respiratoria aguda y coagulación intravascular diseminada (CID). A pesar del tratamiento y manejo de sostén tiene una mala evolución, falleciendo a las 48 horas del ingreso. El caso nos recuerda que la exposición a condiciones de calor por arriba de la temperatura corporal, deteriora los mecanismos de control de calor corporal y metabólico. Es necesario un diagnóstico rápido y un manejo de sostén para conseguir una evolución satisfactoria.

A heat stroke is a very rare and under diagnosed entity. The rise in the body’s temperature is the element that triggers the metabolic dysfunctions that can even lead to death. A case of a soldier is presented; this soldier was training, doing his infantry exercises routine, during September, in days were extreme climate situations were happening, installing a case of primary Multiple Organ Dysfunction (MOD) syndrome. The soldier was taken to the Emergency Service in Fray Bentos’ Hospital, in Rio Negro. The initial evolution was clumsy and slowly, and the neurologic and breathing functions were worsening, with acute renal failure, and also hematological dysfunction. In addition to this, the patient was in need of mechanic ventilation. The diagnosis of temperature shock, acute renal injury, Rhabdomyolysis, acute respiratory failure and disseminated intravascular coagulation (DIC) were established. Supportive care was given to the patient, with an un satisfactory development, leading to death 48 hours after the hospital admission. This case reminds us that, the exposure to weather conditions that are over the body temperature interferes in the metabolism and the body’s mechanisms for controlling heat. A quick diagnosis and supportive care are needed in order to achieve a satisfactory evolution.

Heat stroke victims in Sukkur city of Sindh - Pakistan

This is a descriptive, cross-sectional study, conducted on 14 cases of heat stroke and hyperpy-rexia admitted in Civil Hospital, Sukhur between 1st Jan. and 31st Dec, 2006. The objective was to evaluate the clinical presentation, socio-demographic pattern and to suggest preventive strategies for the control of this problem. Data analysis showed mean age was 32.86 with S.D. +/- 17.06. 85.7 were males and 14.37 females, making a male to female ratio of 6:1 occupation wise, date showed 7.17, house wives, 28.47, labourers, 43.9% farmers and 21.4% were children. With proper and efficient management the cure rate was 100%. Study concluded that the lives of the victims of heat stroke and hyperpyrexia could be saved with proper preventive measures, first aid programmes and efficient treatment practices

Colapso pelo calor esforço induzido: reconhecimento para salvar vidas e tratamento imediato em instalações atléticas / Exertional heat stroke: life-saving recognition and onsite treatment in athletic settings

O prognóstico do colapso pelo calor esforço induzido depende do produto do tempo de duração em que a temperatura central ficou elevada e do grau da elevação. O atleta com EHS que tem pronta descoberta e que é resfriado de maneira eficiente, muito provavelmente irá sobreviver ao episódio com pouco ou nenhum efeito residual. Em contraste, o atleta com apresentação atrasada para o tratamento, especialmente se a área sob a curva de resfriamento for > 60 graus-minuto (centígrados) terá um curso complicado e geralmente fatal. Os métodos de condução do resfriamento com imersão em gelo ou água gelada ou envolvimento em toalhas com água gelada proporcionarão uma rápida e consistente redução da temperatura de todo o corpo, que irá salvar tanto os órgãos quanto a vida. O reconhecimento depende em alto grau da suspeita por parte dos próprios atletas, treinadores e pessoal médico local. Em condições de alto risco, os atletas devem se supervisionar, procurando por mudanças sutis que podem ser sinais de EHS.(AU)The prognosis for exertional heat stroke depends upon the product of length of time the core temperature is elevated and the degree of elevation. The athlete with EHS who is discovered promptly and efficiently cooled will most likely survive the episode with little if any residual. In contrast, the athlete who has delayed presentation for treatment, especially if the area under to cooling curve is > 60 degree-minutes (centigrade), will have a complicated and often fatal course. Conductive cooling methods with ice or cool water immersion or rotating ice water cooled towels provide rapid and consistent whole body temperature reduction that is both organ and life saving. Recognition depends on a high index of suspicion on the part of athletes, coaches, and onsite medical personnel. In high risk conditions, athletes should "buddy up" to watch for subtle changes that can signal the onset of EHS.(AU)El pronóstico del choque térmico (CT) relacionado con el ejercicio depende...

Prevención de enfermedades estivales / Prevention of summer diseases

En este artículo se informa cómo las variaciones climáticas afectan la salud de la población y se analizan las enfermedades más comunes en el período estival, así como la forma de prevenirlas, con el objetivo de promover el rol educador de los enfermeros

Muerte súbita en atletas y golpe de calor: la importancia de un diagnóstico precoz / Sudden death in the athletes and heat stroke: the importance of a prompt diagnosis

Un joven de 25 años sin enfermedades previas conocidas, se colapsa durante un medio maratón en el mes de diciembre (temperatura ambiente 36§C). Luego de su admisión presentó hipertermia central, arritmia ventricular compleja, deterioro neurológico, rabdomiolisis, anuria y coagulación intravascular diseminada, falleciendo en el término de pocos minutos. La muerte súbita en el atleta plantea un desafío desde el punto de vista médico como social. Las enfermedades que la causan se suelen agrupar de acuerdo con su prevalencia -dada por la edad del sujeto-, siendo notoria en muchas casuísticas la ausencia de una entidad potencialmente letal (pero rápidamente reversible) como es el golpe de calor. Este es un cuadro de instalación súbita, debido a una gran producción de calor y a la dificultad para su disipación. Si ambas condiciones persisten, se genera fallo multiorgánico y finalmente colapso cardiovascular. La importancia del diagnóstico precoz se evidencia en que la normalización rápida de la temperatura central elimina dichas complicaciones, mientras que la demora en reconocer el cuadro puede producir secuelas graves o incluso la muerte del sujeto. En la discusión se exponen las diferencias con el golpe de calor clásico y las medidas que deben adoptarse (tanto médicas como generales) para modificar la evolución natural de esta entidad.

Efectos de la clonidina sobre el bochorno y otros síntomas asociados en la mujer menopáusica

Se someten a terapia treinta y ocho (38) pacientes con 150 mcgrs. de clonidina al día durante dos semanas, de las cuales ocho recibieron terapia inicial con placebo por igual período, observándose posteriormente los cambios en la sintomatología menopáusica como respuesta a la terapia dada y los efectos colaterales de la droga. SSe establece una comparación entre los efectos observados al administrar clonidina o placebo encontrándose que se controló en un 90 por ciento de los casos el bochorno y en un 65 por ciento a 80 por ciento los otros síntomas menopáusicos asociados con la clonidina , mientras que con el placebo no se obtuvo mejoría alguna. No se encontraron efectos colaterales intolerables por las pacientes. Las pacientes hipertensas, con síntomas menopáusicos asociados presentaron una mayor respuesta a la clonidina. Se concluye que la clonidina sirve como tratamiento eficaz y alternativo para el tratamiento del bochorno y otros síntomas asociados en las mujeres menopáusicas