Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19.

BACKGROUND: Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. METHODS: A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. RESULTS: A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546-0.632) and 0.567 (95% CI: 0.526-0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628-0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582-0.667) and 0.706 (95% CI: 0.669-0.742), respectively. CONCLUSION: PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19.

Evolución histórica de la psicología médica y su riqueza para la formación humanista y psicológica del médico general / Historical evolution of medical psychology and its wealth for the humanistic and psychological formation of the general practitioner

El objetivo de este artículo se basa en el principio de que el ser humano aprende de su pasado, de ahí que contar con la evolución histórica de la materia ‘Psicología médica’ enriquece la conciencia de quienes la imparten y fortalece sus raíces y las del Departamento de Psiquiatría y Salud Mental de la Facultad de Medicina de la Universidad Nacional Autónoma de México que la fundó, además de que establece las bases para proteger y fomentar su importancia dentro del currículo de la carrera de médico y da a conocer la materia a otras universidades que también consideran que es una asignatura indispensable en la formación de los médicos. Basándose en el análisis de diversas fuentes de información, se reconoce la importancia de sus profesores, de sus programas y del apoyo que brinda a la formación de los futuros médicos

This article is based on the principle that human beings learn from their past, hence having the historical evolution of ‘Medical Psychology’ course, enriches the conscience of those who teach it, strengthens their roots and those of the Department of Psychiatry and Mental Health of the Faculty of Medicine of the National Autonomous University of Mexico who founded it and, lays the basis for protecting and promoting its importance within the curriculum of medical career and makes it known to other universities that also consider that it’s indispensable in the formation of their doctors. Based on the analysis of different sources of information, it recognized the importance of their teachers, their programs and support provided for the training of future doctors

[Circadian blood pressure variation in normal pregnancy, gestational hypertension, and preeclampsia]. / Variación circadiana de la presión arterial en gestantes sanas, con hipertensión gestacional y con preeclampsia.

BACKGROUND AND OBJECTIVE: Changes in circadian variation of blood pressure could be used either to predict preeclampsia or to assess its severity. With the objective of identifying potential differences in blood pressure at the early stages of pregnancy, we examined and compared the characteristics of circadian variability in blood pressure in healthy and complicated pregnant women who were systematically monitored throughout gestation. SUBJECTS AND METHOD: We analyzed 2,014 blood pressure series sampled through ambulatory monitoring for 48 hours once every 4 weeks from the first obstetric visit until delivery. The study included 205 women with uncomplicated pregnancy, 92 with gestational hypertension and 31 with preeclampsia. The circadian pattern of blood pressure variation for each group and trimester of gestation was established by means of a population multiple-components analysis. RESULTS: Differences in the 24-hour mean between healthy and complicated pregnancies were highly significant in all trimesters (p < 0.001), with values of 15.1 and 9.1 mmHg for systolic and diastolic blood presure, respectively, in the third trimester of pregnancy. The 24-hour mean of systolic/diastolic blood pressure for complicated pregnancies was always below 120/72 mmHg. Results further indicated similar circadian characteristics between gestational hypertension and preeclampsia in the first trimester of pregnancy. The difference between these two groups in the 24-hour mean was significant in the second trimester for systolic (3 mmHg; p = 0.002) but not diastolic blood pressure (0.9 mmHg; p = 0.230). In the third trimester, the difference between gestational hypertension and preeclampsia was significant for both variables (5.4 and 3.7 mmHg for systolic and diastolic blood pressure, respectively; p < 0.001). CONCLUSIONS: The differences in blood pressure between healthy and complicated pregnancies, which are observed as early as the first trimester of pregnancy, are detected when both systolic and diastolic blood pressure measurements in women with a late diagnosis of gestational hypertension or preeclampsia fall within accepted ranges of normotension. These differences offer new end points that may lead to an early identification of hypertensive complications in pregnancy as well as to the establishment of prophylactic interventions.

Variación circadiana de la presión arterial engestantes sanas, con hipertensión gestacional y con preeclampsia / Blood pressure variation in normal pregnancy, gestational hypertension, and preeclampsia

FUNDAMENTO Y OBJETIVO: Los cambios en el patrón de variación circadiana de la presión arterial pueden utilizarse para predecir la preeclampsia o para valorar su gravedad. Con el objetivo de identificar posibles diferencias en la presión arterial en estadios tempranos del embarazo, hemos evaluado y comparado el patrón de variación circadiana de la presión arterial en gestantes sanas y con complicaciones de la hipertensión arterial al embarazo que fueron monitorizadas sistemáticamente a lo largo de la gestación. SUJETOS Y MÉTODO: Se analizaron 2.014 series de presión arterial monitorizadas automáticamente durante 48 h cada 4 semanas desde la primera visita obstétrica hasta el parto en 205 gestantes normotensas, 92 que desarrollaron hipertensión gestacional y 31 con preeclampsia. El patrón circadiano de variación de la presión arterial para cada grupo de gestantes en cada trimestre de gestación se determinó mediante un análisis de componentes múltiples poblacional. RESULTADOS: En comparación con los embarazos sin complicaciones, las gestantes que desarrollaron hipertensión gestacional o preeclampsia se caracterizan por una elevación estadísticamente significativa en la media diaria de la presión arterial en todos los trimestres (p < 0,001), con diferencias entre grupos de 15,1 mmHg en presión sistólica y de 9,1 en presión diastólica en el tercer trimestre de gestación. La media diaria de las gestantes con complicaciones estuvo siempre por debajo de 120/72 mmHg para la presión sistólica/diastólica. Los resultados indican, además, que la media diaria es similar en el primer trimestre entre gestantes que desarrollaron hipertensión gestacional y preeclampsia. La diferencia entre estos grupos es estadísticamente significativa en el segundo trimestre en la presión sistólica (3 mmHg; p = 0,002), pero no en la diastólica (0,9 mmHg; p = 0,230). Las diferencias fueron altamente significativas, sin embargo, en el tercer trimestre (5,4 y 3,7 mmHg para la presión sistólica y diastólica, respectivamente; p < 0,001). CONCLUSIONES: Las diferencias de presión arterial entre grupos de gestantes aparecen con valores medios que están dentro de los márgenes aceptados de normotensión, incluso para la mayoría de las mujeres que desarrollaron hipertensión gestacional o preeclampsia. Estas diferencias, significativas ya desde el primer trimestre, ofrecen nuevos parámetros para la identificación temprana de complicaciones hipertensivas en el embarazo y el establecimiento de medidas profilácticas (AU)

Differences in circadian blood pressure variability during gestation between healthy and complicated pregnancies.

BACKGROUND: Changes in circadian variation of blood pressure (BP) could be used either to predict preeclampsia or to assess its severity. We examined and compared characteristics of circadian variability in BP in women with both healthy and complicated pregnancies who were systematically monitored throughout gestation. METHODS: We analyzed 2430 BP series sampled by ambulatory monitoring for 48 h once every 4 weeks from the first obstetric visit until delivery in 235 women with uncomplicated pregnancies, 128 with gestational hypertension, and 40 with preeclampsia. The circadian pattern of BP variation for each group and trimester of gestation was established by population multiple-components analysis. RESULTS: The differences in 24-h mean and amplitude between healthy and complicated pregnancies were highly significant in all trimesters (P < 0.001). Results further indicated similar circadian characteristics between gestational hypertension and preeclampsia in the first trimester of pregnancy. The difference between these two groups in 24-h mean was statistically significant for systolic (P =.002) and diastolic BP (P =.038) in the second trimester and, to a larger extent, in the third trimester (P < 0.001). CONCLUSIONS: The differences in BP between healthy and complicated pregnancies that can be observed as early as in the first trimester of pregnancy are found when both systolic and diastolic BP for women with a later diagnosis of gestational hypertension or preeclampsia are well within the accepted range of normotension. These differences offer new end points that may lead to an early identification of hypertensive complications in pregnancy as well as to the establishment of prophylactic intervention.