Validez diagnóstica de cinco escalas de predicción clínica para la trombosis venosa profunda (TVP)

Introducción: la trombosis venosa profunda (TVP) es una entidad común que afecta principalmente el sistema venoso profundo de los miembros inferiores, para el cual se han desarrollado múltiples escalas de predicción clínica, las cuales han sido construidas y validadas en pacientes ambulatorios y hospitalizados. Objetivos: validar cinco escalas de predicción clínica para TVP en pacientes atendidos en un centro de tercer nivel en la sabana de Bogotá, Colombia. Métodos: se llevó a cabo un estudio de corte transversal con análisis de prueba diagnóstica en sujetos con sospecha de TVP, incluyendo aquellos que contaran con la realización de ecografía Doppler venosa de miembros inferiores. Se calculó el rendimiento de cinco escalas de predicción clínica para TVP (Wells clásico y modificado, Oudega, CEBI y Constans) para pacientes ambulatorios u hospitalizados, individualizando la población en la que fueron validadas. Resultados: ingresaron al análisis 974 pacientes, de estos 485 (49,7 %) presentaron TVP. La escala de Constans tuvo un mejor rendimiento diagnóstico entre los pacientes hospitalizados y ambulatorios, con un área bajo la curva ROC de 0,73 (95 % 0,70-0,78) al compararla con Wells clásico, Wells modificado, Oudega y CEBI. Al comparar el rendimiento de Constans en ambos grupos de pacientes por separado, también se observó un mejor rendimiento con respecto a las demás escalas. Conclusión: la escala de Constans presenta un mejor rendimiento diagnóstico comparado con las demás escalas al ser aplicada en paciente hospitalizados y ambulatorios.

Summary Introduction: The deep vein thrombosis (DVT) is a common entity that mainly affects the deep venous system of the lower limbs, for which multiple clinical prediction scales have been developed, which have been constructed and validated in outpatients and inpatients. Objetives: We aimed to validated five clinical prediction scores for the diagnosis of lower limb DVT in patients from La Sabana de Bogota, Colombia. Methods: A cross-sectional study with analysis of a diagnostic test was carried out in patiens with suspected deep vein thrombosis, including those who had venous Doppler ultrasound of the lower limbs for suspected DVT. The performance of five clinical prediction scales for DVT (classic and modified Wells, Oudega, CEBI and Constans) for outpatients and inpatients was calculated in those scores who are validated in both populations and only in ambulatory or hospitalized patients for those that are specific scores. Results: Nine hundred seventy-four patients were entered into the analysis, of which 485 (49.7%) presented DVT. The Constans scale had a better diagnostic performance among inpatients and outpatients with an area under the ROC curve of 0.73 (95% 0.70-0.78) when compared with classic Wells, modified Wells, Oudega and CEBI. When we compared Constans performance in both groups of patients separately, we observed better performance with respect to the other scores. Conclusion: The Constans scale presents a better diagnostic performance compared to the other scales when applied to inpatients and outpatients.

Validity of the Pulmonary Embolism Rule-Out Criteria (PERC) for ruling out pulmonary embolism in low-risk patients at high altitudes

Abstract Objectives: to validate the diagnostic yield of the PERC score for ruling out pulmonary embolism in low-risk patients at high altitudes (>2500 meters above sea level [ASL]). Methods: a cross-sectional study with diagnostic test analysis in patients over the age of 18 with suspected pulmonary embolism on admission or during hospitalization, who underwent chest computed tomography angiography between August 2009 and January 2020 in a tertiary care hospital located on the Bogotá savannah. The yield of the PERC score was assessed, calculated with an SaO2<95% and an SaO2<90% in patients with different risk levels according to the Wells, Geneva and Pisa scores for pulmonary embolism. Results: one thousand eighty-seven were included in the final analysis, 42% with PE. Patients classified as low-risk using the Wells score had a PERC ACOR calculated with SaO2<95% of 0.56 (95%CI:0.50-0.62) (p=0.049), and calculated with SaO2<90% of 0.60 (95%CI:0.54-0.66) (p=0.002). The ACOR for subjects classified as low-risk using the Geneva score, with a PERC calculated with SaO2<95%, was: 0.53 (95%CI:0.45-0.60) (p=0.459) and for a PERC calculated with SaO2<90% it was: 0.55 (95%CI:0.47-0.62) (P=0.218). The ACOR for subjects with a less than 10% probability of PE according to the Pisa score classification, with a PERC calculated with SaO2<95%, was: 0.54 (95%CI:0.44-0.64)(p=0.422), and for a PERC calculated with SaO2<90% it was: 0.56 (95%CI:0.46-0.66)(p=0.236). Conclusions: the PERC score calculated with an oxygen saturation <90% has a similar diagnostic yield to the PERC score calculated with an oxygen saturation <95% for ruling out PE in patients classified as low-risk by the Wells score at high altitudes (>2,500 meters ASL). (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2010).

Panorama mundial de las diferentes plataformas de vacunas contra el COVID-19: revisión y reflexión de la literatura actual / Worldwide Overview of the Different COVID-19 Vaccine Platforms: A Review and Reflection on the Current Evidence

RESUMEN Las vacunas son productos biológicos que contienen antígenos que buscan generar protección contra a la exposición real de un agente patógeno. En cuanto a su importancia, hacen parte de las intervenciones más costo-efectivas en salud pública, siendo superadas únicamente por el agua potable. A grandes rasgos, podemos dividir las vacunas en vivas atenuadas e inactivadas; no obstante, el nuevo coronavirus ha producido la emergencia de plataformas innovadoras que utilizan mecanismos intracelulares y moleculares con el mismo objetivo de generar inmunidad. Se realizó una búsqueda sistemática de la literatura utilizando las bases de datos electrónicas Pubmed, Scopus y Web of Science. Todos los tipos de diseño de estudio fueron considerados, sin embargo, se prefierieron aquellos redactados en idioma inglés o español. Se hace una revisión de la literatura presente sobre las plataformas existentes para generar inmunidad frente al coronavirus SARS-CoV-2 y se desarrolla cada una según su ruta y forma de acción en aquellas basadas en subunidades proteicas, vector viral recombinante, ácidos nucleicos, virus inactivados, partículas virales y virus vivos atenuados. Los mecanismos por los cuales dichas vacunas generan inmunogenicidad son diferentes, no obstante, la constante inserción de mutaciones por parte del virus sigue siendo un objeto de interés y preocupación por los investigadores.

ABSTRACT Vaccines are biological products containing antigens that aim to generate protection against real exposure to an infectious pathogen. They constitute the most cost-effective interventions in public health, being surpassed only by drinking water. Generally speaking, we can divide the vaccines into live attenuated and inactive; However, the new coronavirus has produced innovative platforms that use intracellular and molecular mechanisms with the same objective of generating immunity. A systematic literature search was carried out using the PUBMED, SCOPUS, and Web of Science electronic databases. All types of study design were selected, those written in English or Spanish were prioritized. We reviewed the existing platforms to generate immunity against the SARS-CoV-2 coronavirus. Each one is developed according to its route and form of action, and can be classified as protein subunits, recombinant viral vector, nucleic acids, inactivated viruses, viral particles, and live attenuated viruses. The mechanisms by which these vaccines generate immunogenicity are different; however, the constant insertion of mutations by the virus remains an object of interest and concern for researchers.