RESUMEN
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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , SARS-CoV-2 , COVID-19 , Embolia y Trombosis , Consenso , AnticoagulantesRESUMEN
Abstract Hypertriglyceridemic pancreatitis (HTGP) is the third cause of acute pancreatitis in most studies, with a triglyceride (TG) risk value of more than 1000 mg/dL. The pathophysiological mechanism involves triglyceride hydrolysis by pancreatic lipase and the release of fatty acids which cause damage by producing free radicals. The reduction of TGs below 500 mg/dL is the treatment goal, based on increased lipoprotein lipase activity and chylomicron degradation. We present the case of a patient with HTGP with an adequate response to concomitant insulin and heparin therapy. (Acta Med Colomb 2020; 45. DOI: https://doi.org/10.36104/amc.2020.1491).
Resumen La pancreatitis secundaria a hipertrigliceridemia (PASHT) es la tercera causa de pancreatitis aguda en la mayoría de series, teniendo como factor de riesgo un valor de triglicéridos (TG) mayor a 1000 mg/dL. El mecanismo fisiopatológico involucra la hidrólisis de triglicéridos por la lipasa pancreática y la liberación de ácidos grasos que inducen el daño por la generación de radicales libres. La reducción de los TG a niveles menores de 500 mg/dL es el objetivo del tratamiento, basado en el aumento de la actividad de la lipoproteinlipasa y degradación de quilomicrones. Presentamos un caso de un paciente que presenta PASHT con adecuada respuesta al manejo concomitante de insulina y heparina.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1491).
Asunto(s)
Humanos , Adulto , Heparina , Insulina , Pancreatitis , Triglicéridos , Lipoproteína LipasaRESUMEN
Abstract Introduction: Home-care models are safe and effective alternatives to the care of patients. The day care hospitals provide specialized care and targeted treatments with adequate quality standards, that can fulfill the expectations of patients and their families by different measures. However, this model has not been sufficiently explored in Colombia. This study aims to determine the safety and efficacy in terms of mortality, hospital readmissions and adverse events in the follow-up of a multipurpose day care hospital model focused in patients with internal medicine diseases in Medellín. Design and methods: A retrospective descriptive study of secondary sources, from the medical records registry of 3419 patients seen in an "Early discharge program" between June 2014 and May 2016 in Medellin city, patients were coming from hospitalization rooms of internal medicine and emergency departments of second and third level of complexity attention, and outpatient services. Univariate analyzes were performed through proportions and rates to determine mortality, hospital readmissions, and adverse events in the statistical package epidat version 4.1. Results: The average age was 62.6 ± 18.3 years. 66% were women. The most common diseases were chronic obstructive pulmonary disease (16%), Diabetes mellitus (11.3%), cardiac failure (11%). The rate of readmissions was 2.6% for the same diagnosis as admission to the program, the adverse event rate was 0.66 % and a mortality rate of 0.87 %. Conclusions: This retrospective analysis of the day care hospital model, it's the only one reported so far in Latin American literature, allows us to demonstrate its safety and clinical efficacy in the care of adult patients.
Resumen Introducción: Los modelos de atención domiciliaria son alternativas seguras y eficaces para del cuidado de los pacientes. Los hospitales - día brindan atención especializada y tratamientos dirigidos con adecuados estándares de calidad que logran llenar las expectativas del paciente y sus familias. Sin embargo, este modelo no ha sido lo suficientemente explorado en Colombia. Con este estudio se busca describir la seguridad y eficacia, en términos de mortalidad, reingresos hospitalarios y eventos adversos en un modelo de hospital - día polivalente enfocado en pacientes provenientes de servicios de medicina interna de la ciudad de Medellín. Metodología: Estudio descriptivo retrospectivo de fuentes secundarias, de registros de 3 419 pacientes atendidos en el "Programa de altas tempranas", procedentes de salas de hospitalización de medicina interna y urgencias de instituciones de segundo y tercer nivel de complejidad, y servicios ambulatorios. Se determinó la mortalidad, reingresos hospitalarios y eventos adversos. Resultados: Edad promedio 62,6 ± 18,3 años. El 66 % eran mujeres. Las enfermedades más comunes fueron enfermedad pulmonar obstructiva crónica (16 %), diabetes mellitus (11,3 %) e insuficiencia cardíaca (11 %). La tasa de reingresos fue 2,6 %, una proporción de eventos adversos del 0,66 % y una mortalidad de 0,87 %. Conclusiones: Este análisis es el único reportado hasta el momento en literatura de Latinoamérica y ayuda a demostrar la seguridad y eficacia clínica en la atención de los pacientes adultos.