Utility of a clinical risk scale to predict the requirement of advanced airway management in patients with a diagnosis of deep neck abscess.

OBJECTIVES: To analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. METHODS: Observational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p<0.05 was considered significant. RESULTS: A sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p=0.001) as well as the multiple spaces involvement, (p=0.001) the presence of air corpuscles, (p=0.001) compromise of the retropharyngeal space (p=0.001) and age greater than 55 years (p=0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p=0.001, 95% CI 0.856-0.984). CONCLUSIONS: The clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. LEVEL OF EVIDENCE: IV.

[Risk factors at admission associated with intubation in patients with COVID-19]. / Factores de riesgo al ingreso asociados a intubación en pacientes con COVID-19.

Background: Intubation rates up to 33% have been found in patients diagnosed with COVID-19. Some cohorts have reported the presence of dyspnea in 84.1% of intubated patients, being this the only symptom associated with intubation. Oxygen saturation < 90% and increased respiratory rate have also been described as predictors of intubation. Objective: To analyze the risk factors associated with intubation in patients hospitalized for COVID-19 at their admission. Material and methods: An observational, retrospective, analytical, cross-sectional study was carried out. The universe of study consisted of patients over 18 years of age hospitalized due to a diagnosis of SARS-CoV-2 virus infection from April 1, 2020 to April 31, 2021 in the Hospital de Especialidades (Specialties Hospital) "Dr. Bernardo Sepúlveda Gutiérrez" at the National Medical Center. Results: The mean age of intubated patients was 59.17 years (95% confidence interval [95% CI] -9.994 to -3.299, p < 0.001). Overall, 76.7% (230) of patients had a history of one or more preexisting comorbidities, including hypertension in 42.3% (127), obesity in 36.7% (110), and diabetes mellitus in 34.3% (103). Conclusions: The main clinical characteristics of patients hospitalized for COVID-19 in our center who required intubation are very similar to those observed in different centers, including male sex, age over 50 years and obesity, which were the most common.

Introducción: se han encontrado tasas de intubación de hasta 33% en pacientes con diagnóstico de COVID-19. Algunas cohortes han informado la presencia de disnea en el 84.1% de los pacientes intubados y este ha sido el único síntoma asociado con la intubación. La saturación de oxígeno < 90% y el aumento de la frecuencia respiratoria también han sido descritos como predictores de intubación. Objetivo: analizar los factores de riesgo asociados a intubación en pacientes con COVID-19 al momento de su admisión hospitalaria. Material y métodos: se realizó un estudio observacional, transversal, analítico y retrospectivo. El universo de estudio consistió en pacientes mayores de 18 años, hospitalizados por diagnóstico de infección por virus SARS-CoV-2 del 1 abril de 2020 al 31 abril de 2021 en el Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez" del Centro Médico Nacional. Resultados: se analizaron un total de 300 pacientes. La media de edad de los pacientes intubados fue de 59.17 años (p < 0.001, intervalo de confianza del 95% [IC 95%] −9.994 a −3.299). En general, el 76.7% (230) de los pacientes tenía antecedentes de una o más comorbilidades preexistentes, incluida la hipertensión en 42.3% (127), la obesidad en 36.7% (110) y la diabetes mellitus en 34.3% (103). Conclusiones: las principales características clínicas de los pacientes hospitalizados por COVID-19 en nuestro centro que requirieron de intubación son muy similares a las observadas en distintos centros, entre ellas el sexo masculino, la edad mayor de 50 años y la obesidad, que fueron las más prevalentes.

Interleukin 8 Is Overexpressed in Acute Rejection in Kidney Transplant Patients.

The main complication associated with renal graft loss is immune rejection. The gold standard for the diagnosis of renal graft rejection is percutaneous renal biopsy, which is expensive and can lead to complications. Inflammation is one of the main pathogenic pathways in allograft rejection, and urine samples seem to be efficient windows to explore the allograft condition with a high cost-benefit ratio. This study aimed to evaluate the messenger ribonucleic acid (mRNA) profile expression pattern for interleukin (IL) 2, IL-4, IL-6, IL-8, and IL-10; tumor necrosis factor alfa; gamma interferon; and transforming growth factor ß1 in the urine renal cells of patients with a diagnosis of humoral rejection and patients with a diagnosis of normal biopsy. METHODS: An observational, cross-sectional analytical study was performed. All kidney transplants were performed at the Organ Transplant Department between 2018 and 2019. Also, a healthy control with a normal blood test and no apparent infection was included. mRNA from urine samples and biopsies was isolated, and the expression of interleukins was analyzed in PCR real time. Data were analyzed by Shapiro-Wilk and Kruskal-Wallis tests. RESULTS: The proinflammatory IL expression pattern in urine samples of kidney rejection group showed overexpression for IL-8 (P = .0001). No differences were observed in the rest of the interleukins analyzed. When we compared the results in the rejected versus not rejected transplanted patients with a group of apparently healthy subjects, the difference remains consistent. Thus, mRNA of IL-8 could function as a diagnostic tool in cases of chronic damage secondary to fibrosis.

Kidney Donor Profile Index in a Transplant Center in Mexico.

BACKGROUND: The Kidney Donor Profile Index (KDPI) was created in 2014 to measure the likelihood of graft failure for a given donor compared with the median kidney donor from the previous year. This scale is based on the American population only. Mexico is one of the countries with greater incidence of chronic kidney disease, a long waiting list, and not enough kidney donors with KDPI smaller than 80%. This has led transplant centers to take kidney grafts with a higher KDPI. OBJECTIVE: To investigate the agreement between the KDPI and histologic scores (preimplantation renal biopsy) and assess the relationship between the Kidney Donor Risk Index (KDRI), KDPI, and the histologic score on graft survival. METHODS: A retrospective, analytical, transversal study was performed. Data were collected from patients with kidney grafts from deceased donors from January 1, 2011, to June 30, 2019, at our hospital. The variables analyzed were age, weight, height, sex, race and/or ethnicity, history of hypertension or diabetes, cause of death, serum creatinine, KDPI, KDRI, and biopsy result from each graft prior to transplant. RESULTS: The total population was 59 deceased kidney donors. For our patients, a high KDPI did not increase mortality rate; it provided greater benefit than staying on dialysis. CONCLUSIONS: We conclude that the use of KDRI should only be considered to assess the degree of fibrosis, not to rule out a transplantable kidney, in addition to the consistent demonstration that high KDPI kidneys (even 91%-100%) confer greater survival benefits to patients regarding the waiting list.

Main factors affecting the loss of multi organ potential donors for transplantation.

ANTECEDENTS: In the field of organ donation and procurement, a possible donor is a patient with severe neurological damage and appropriate medical criteria for donation, and a potential donor is a patient suspected of being brain dead. OBJECTIVE: The aim of this study is to identify specific factors that cause the loss of possible multiorgan donors in an intensive care unit (ICU). METHODS: A review of cross-sectional charts of possible liver and kidney donors was done with patients admitted to the ICU with full respiratory support and Glasgow score < 8. A multiple logistical regression model was applied to identify the loss of potential donors previously considered only as possible donors. RESULTS: A total of 44 charts were reviewed, 26 were possible, and 18 were potential donors. The mean average was 46.7 and 52.8 years for possible and potential donors, respectively (p = 0.272). The potential donors experienced frequent intracranial hemorrhage (19.2 vs. 55.6) or renal injury (3.9 vs. 27.8), and fewer invasive procedures are performed (34.6 vs. 5.6) (p <0.05). Invasive procedure resulted significant (p = 0.013) when a multivariate analysis was done. DISCUSSION AND CONCLUSIONS: Patients submitted to invasive procedures have 20 times more probabilities of being lost as kidney donors even when originally considered as possible donors. Medical or surgery procedures are the leading cause for the loss of potential donors, so an opportune detection is essential.

ANTECEDENTES: En el campo de la donación y la procuración renal, un posible donador es un paciente con daño neurológico grave y que cubre los criterios médicos para la donación; un potencial donador es el paciente que, además, cuenta con la sospecha de tener muerte cerebral. OBJETIVO: Identificar los factores específicos que causan la pérdida de posibles donadores multiorgánicos en una unidad de terapia intensiva. METODOLOGÍA: Se realizó un estudio retrospectivo transversal de los expedientes de los posibles donadores de riñón e hígado admitidos a la unidad de terapia intensiva con soporte respiratorio total y escala de Glasgow < 8. Se aplicó un modelo de regresión logística para identificar los casos perdidos de potenciales donadores previamente considerados solo como posibles donadores. RESULTADOS: Se revisaron 44 casos, 26 de posibles y 18 de potenciales donadores. La edad promedio fue de 46.7 y 52.8 años para los posibles y potenciales donadores, respectivamente (p = 0.272). Los potenciales donadores experimentaron con más frecuencia hemorragia intracraneal (19.2 vs. 55.6) o lesión renal (3.9 vs. 27.8), y fueron sometidos a menos procedimientos médicos (34.6 vs. 5.6) (p < 0.05). En el análisis multivariado, la realización de algún procedimiento invasivo fue significativa entre los dos grupos (p = 0.013). DISCUSIÓN Y CONCLUSIONES: Los pacientes sometidos a un procedimiento invasivo tienen 20 veces más probabilidades de perderse como donadores renales aun siendo considerados de manera original como posibles donadores. Los procedimientos médicos o quirúrgicos son la principal causa de pérdida de potenciales donadores, por lo que es esencial una detección precoz y oportuna de los mismos.