ABSTRACT
Resumen Introducción: La infección por SARS-CoV-2 en la mayoría de los casos tiene un curso leve, aunque la insuficiencia respiratoria aguda se asocia a mayor mortalidad. Objetivo: Determinar la mortalidad global en pacientes con COVID-19 hospitalizados o en una unidad de cuidados intensivos (UCI). Métodos: Análisis inferencial a partir de una base de datos del periodo enero de 2020-diciembre de 2021, de la Dirección General de Epidemiología de México. Se incluyeron pacientes hospitalizados positivos a SARS-CoV-2. Se describieron las características generales y se realizó un modelo de regresión binaria para determinar las asociaciones con la mortalidad. Resultados: Se identificaron 116 446 pacientes que requirieron ingreso hospitalario. La mortalidad global fue de 44 %, la intrahospitalaria de 33 % y en la UCI de 33 %. La mortalidad de pacientes con ventilación mecánica e ingreso hospitalario fue de 87 % y en la UCI de 75 %. En el sector público predominaron los ingresos al Instituto Mexicano del Seguro Social y a la Secretaría de Salud, cada uno con RM = 2.24 (p = 0.004) y RM = 2.55 (p = 0.001) para mortalidad. Conclusión: La mortalidad fue mayor en el sector público y pudo deberse a la saturación de los servicios, lo que condicionó escasez de recursos.
Abstract Introduction: SARS-CoV-2 infection has in, most cases, a mild course, although acute respiratory distress syndrome is associated with higher mortality. Objective: To determine overall mortality in hospitalized or intensive care unit (ICU)-admitted COVID-19 patients. Methods: Inferential analysis from a database of the General Directorate of Epidemiology of Mexico. SARS-CoV-2-positive patients, hospitalized within the January 2020-December 2021 period, were included. General characteristics were described and a binary regression model was created to determine associations with mortality. Results: 116,446 patients who required hospital admission were identified. Overall mortality was 44%; in-hospital mortality, 33%; and ICU mortality, 33%. Mortality of patients with mechanical ventilation and hospital admission was 87%, and with ICU admission, 75%. In the public sector, hospital admissions at the Mexican Institute of Social Security and the Ministry of Health predominated, with OR = 2.24 (p = 0.004) and OR = 2.55 (p = 0.001), respectively, for mortality. Conclusion: Mortality was higher in the public sector, and this could be due to the overcrowding of services, which determined a scarcity of resources.
ABSTRACT
The evaluation of the diaphragm in critically ill patients is simple and noninvasive and has shown good repeatability. The aim of the study was to generate a predictive index for successful weaning (ULDIMex) from invasive mechanical ventilation (IMV) based on an ultrasonographic diaphragmatic assessment before performing a spontaneous breathing test. We recruited patients who required IMV and who were candidates for weaning from ventilation. The measurement of diaphragmatic excursion and time during inspiration and expiration was obtained with a 3- to 5-MHz probe in the M mode. Using the formula (a + b)c/2, the value for the ULDIMex was obtained to evaluate its impact on predicting the successful weaning of IMV, where a is the time during the inspiratory phase, b is the time during expiration, and c is the diaphragmatic excursion during the inspiratory phase, which corresponds to the highest point of the curve from the baseline. We recruited 114 patients, of whom 86 (76%) were successfully weaned from IMV. The patients who were successfully weaned from the IMV had a cutoff value greater than 4.06 cm/s for the ULDIMex index, with a sensitivity of 92.8% (95% confidence interval, 76.5-99.1), specificity of 63.9% (95% confidence interval, 52.9-74.0), positive predictive value of 45.6%, and negative predictive value of 96.5%. The ULDIMex index demonstrated a good level of discrimination for successful weaning prediction. Considering the excellent negative likelihood ratio of the ULDIMex index of greater than 4.06, this index may be considered before performing an spontaneous breathing test to identify critically ill adult patients who will extubate successfully.
Subject(s)
Critical Illness , Diaphragm/diagnostic imaging , Diaphragm/physiopathology , Ultrasonography/methods , Ventilator Weaning , Adult , Female , Humans , Male , Mexico , Predictive Value of TestsABSTRACT
Dengue virus is the most prevalent arbovirus in Mexico, and although the diversity of this virus has been studied, the vast majority of sequences have been derived from viruses isolated from the human host. In this work, we aimed to sequence and to analyze DENVs derived from wild mosquitoes captured in Acapulco Guerrero, Mexico. We succeeded in determining three full genome sequences of such viruses and were able to compare them with other reported sequences from human and mosquito-derived DENVs. We found 15 nonsynonymous and 88 synonymous substitutions that were present more frequently in mosquito viruses than what would be expected by chance, although the limited number of genomes reported so far puts a constraint on the conclusions that can be derived from these analyses. Also, given the high depth of coverage attained in one of the genomes a variant analysis was carried out, finding 68 polymorphic sites in this genome. Interestingly, six of them corresponded to SNV that were detected as potentially differential between mosquitoes and humans, indicating that a that at least some positions may be maintained as polymorphic, which may facilitate host transmission.
Subject(s)
Aedes/virology , Dengue Virus/genetics , Dengue/transmission , Mosquito Vectors/virology , Animals , Genome, Viral/genetics , Genotyping Techniques , Humans , Mexico , Phylogeny , Polymorphism, Genetic , Whole Genome SequencingSubject(s)
Critical Illness , Sepsis , Humans , Multiple Organ Failure , Organ Dysfunction Scores , SimendanABSTRACT
Pulmonary ultrasonography is a complementary study that is easy to perform at the patient bedside with no need to transfer the patient to special areas. The technique provides information with high sensitivity and specificity for different pathologies. Pulmonary ultrasonography is a very important diagnostic tool in the assessment of lung, pleural, and chest wall diseases. Pulmonary ultrasound provides low-cost analysis, easy real-time reproduction, and safety, all of which have made it a beneficial tool in the diagnostic arsenal available to medical personnel. The purpose of this review was to describe the usefulness of pulmonary ultrasound in critical areas.
