Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection can cause alterations in the coagulation mechanism conditioning thrombotic phenomena such as acute limb ischemia (ALI) as the only manifestation of the infection. The aim of the study was to describe clinical and surgical characteristics of a group of patients infected with severe acute respiratory syndrome coronavirus 2 who presented ALI in the context of the COVID-19 pandemic at Lima, Peru. METHODS: A multicenter, observational, and retrospective study was performed in six general hospitals, from March to July 2020. The variables considered were the pathological history and associated habits, laboratory tests, the severity of COVID-19 infection and ALI, the anatomic location of the lesion, treatment, evolution, and discharge conditions. RESULTS: Thirty patients with ALI infected with COVID-19 were evaluated. Their mean age was 60 ± 15 years, the condition being more frequent in men (76.6%). The main comorbidities were arterial hypertension (33.3%), obesity (33.3%), and diabetes mellitus 2 (26.6%). There were 23.3% asymptomatic patients, and their only manifestation was ALI. Rutherford IIA and IIB stage included 93.2% of patients. The most frequent location of the thrombosis was the lower limbs (73.3% vs. 26.6%). Thrombectomy was performed in 76.6% of the patients, and amputation (primary and secondary) was performed in 30% of the patients. The mortality rate was 23.3%, all of it because of acute respiratory distress syndrome. CONCLUSIONS: ALI is a vascular pathology associated with embolic and thrombotic processes. COVID-19 infection can cause severe alterations in coagulation mechanisms, leading some patients to present severe acute arterial complications such as thrombosis, as the only associated manifestation. We report a younger cohort than those described in other studies and with a high frequency of amputations despite adequate surgical treatment.

Características clínicas de la sepsis neonatal temprana en el Hospital Nacional Dos de Mayo, 2015 / Clinical characteristics of the early neonatal sepsis at the National Hospital Dos de Mayo, 2015

Introducción: La sepsis neonatal temprana es un cuadro clínico caracterizado por manifestaciones de infección sistémica que aparece en las primeras 72 horas de vida, en México se encuentran tasas de entre 0.76 y 4.7 por 1000 nacidos vivos, con una letalidad de entre 5.7 por ciento y 9 por ciento. Objetivos: Determinar las características clínicas de los recién nacidos con sepsis neonatal temprana en el Hospital Nacional Dos de Mayo durante el 2015. Diseño: Estudio descriptivo. Lugar: Hospital Nacional Dos de Mayo. Participantes: Pacientes del servicio de Neonatología diagnosticados con sepsis neonatal temprana posible, probable y confirmada. Intervención: Recolección de datos a través de la base de datos de los pacientes del servicio de Neonatología y revisión de historias clínicas. Resultados: Se incluyeron 479 pacientes, 5.4 por ciento fueron confirmados con hemocultivo. 85.4 por ciento fueron neonatos a término, el 75.8 por ciento tuvo adecuado peso al nacer. El factor de riesgo más frecuente fue la ITU en el tercer trimestre del embarazo. La ictericia fue el signo más común y la PCR > 10 mg/dL el hallazgo de laboratorio más frecuente. El estafilococo coagulasa negativo fue el patógeno aislado en la mayoría de casos. 0.83 por ciento del total pacientes fallecieron. Conclusiones: La frecuencia de sepsis neonatal temprana confirmada en el Hospital Nacional Dos de Mayo en el 2015 fue de 9 por 1000 nacidos vivos, la tasa de letalidad fue de 11.5 por ciento.

Introduction: Early-onset neonatal sepsis is a clinical syndrome characterized by manifestations of systemic infection that appears in the first 72 hours of life, in Mexico there are rates between 0.76 and 4.7 per 1000 newborns, with a lethality rate between 5.7 and 9 per cent. Objective: To determinate the clinical features of newborns with early-onset neonatal sepsis in the National Hospital Dos de Mayo during 2015. Design: Descriptive study. Place: National Hospital Dos de Mayo. Participants: Patients from the Neonatology service diagnosed with possible, likely and confirmed early-onset neonatal sepsis. Intervention: Data collection through the Neonatology service patients' database and clinical record review. Results: 479 patients were included, 5.4 per cent were confirmed by blood culture. 85.4 per cent were term infants, 75.4 per cent had adequate birth weight. The most frequent risk factor was the UTI in the third trimester of pregnancy. Jaundice was the most common sign and CRP > 10 mg/dL the most frequent laboratory finding. Coagulase negative Staphylococcus was the most common insolated pathogen. 0.83 per cent of the patients passed away. Conclusions: The frequency of confirmed early-onset neonatal sepsis in the Dos de Mayo National Hospital during 2015 was 9 per 1000 newborns, the lethality rate was 11.5 per cent.