Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability.

Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.

Obesidad como factor pronóstico en el paciente crítico / Obesity as a prognostic factor in the critical ill patients / Obesidade como fator prognóstico no paciente crítico

Resumen: Introducción: La obesidad es una enfermedad con impacto negativo en la sobrevida; se hace referencia al término «paradoja de la obesidad¼ utilizado como un efecto protector en la mortalidad. Objetivo: Determinar si la obesidad es un factor de protección en el paciente crítico. Material y métodos: Se realizó un estudio de cohorte. Se obtuvo información de expedientes de Unidad de Cuidados Intensivos (UCI) del Hospital Regional Monterrey del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) Monterrey durante 2018. Se hizo análisis bivariado para asociación χ2 y U de Mann-Whitney para correlación fórmula de Pearson y análisis de supervivencia con curva de Kaplan-Meier. Resultados: Se analizaron 151 expedientes de pacientes, 73 obesos y 78 no obesos, se observó que la obesidad es un factor protector para mortalidad (p = 0.044, OR 0.431 (IC 0.187-0.992). El IMC no se correlaciona con el Acute physiology and chronic health evaluation (APACHE) II (p = 0.066); sin embargo, con un impacto en la curva de supervivencia (p = 0.42). Conclusiones: Se detecta la obesidad como factor protector; sin embargo, su asociación con enfermedades crónicas degenerativas, estancia prolongada en UCI y sus complicaciones no dejan de tener impacto negativo en la supervivencia fuera de la unidad.

Abstract: Introduction: Obesity is a disease with a negative impact on survival; the prognosis of these patients is has controversial results. The term «obesity paradox¼ refers as a protective effect on mortality. Objective: To determine whether obesity is a protective factor in the critically ill patient. Material y methods: A cohort study was conducted. Data was obtained from ICU records of the ISSSTE Monterrey Regional Hospital during 2018, bivariate analysis was performed for χ2 and Mann Whitney's U association, for Pearson's formula correlation and survival analysis with Kaplan-Meier curve. Results: 151 records of 73 obese and 78 non-obese patients were analyzed, it was observed that obesity is a protective factor for mortality (p = 0.044, OR 0.431(IC 0.187-0.992), BMI does not correlate with APACHE II (p = 0.066), however, an impact on the survival curve was observed (p = 0.42). Conclusions: According to the results obtained, it matches with the term «obesity paradox¼, however, its association with chronic degenerative diseases, prolonged stay in the ICU and its complications do not cease to have a negative impact on survival outside the unit.

Resumo: Introdução: A obesidade é uma doença com impacto negativo na sobrevida; O termo «paradoxo da obesidade¼ refere-se a um efeito protetor sobre a mortalidade. Objetivo: Determinar se a obesidade é um fator protetor em pacientes críticos. Material e métodos: Foi realizado um estudo de coorte. As informações foram obtidas dos registros da UTI do ISSSTE Monterrey Regional Hospital durante o ano de 2018, foi realizada análise bivariada para associação χ2 eU Mann-Whitney, para correlação da fórmula de Pearson e análise de sobrevida com curva de Kaplan-Meier. Resultados: Foram analisados 151 prontuários de 73 pacientes obesos e 78 não obesos, observou-se que a obesidade é fator protetor para mortalidade (p = 0.044, OR 0.431(IC 0.187-0.992), IMC não se correlaciona com APACHE II (p = 0.066), porém, com impacto na curva de sobrevida (p = 0.42). Conclusões: A obesidade é encontrada como fator de proteção, porém, sua associação com doenças crônico-degenerativas, permanência prolongada na UTI e suas complicações não deixam de ter impacto negativo na sobrevida fora da unidade.

Relación de hipercloremia con mortalidad en pacientes postoperados electivamente de resección de tumores intracraneales / Relationship of hyperchloremia with mortality in neurosurgical patients after elective resection of intracranial tumor / Relação da hipercloremia com mortalidade em pacientes após cirurgia eletiva para ressecção de tumores intracranianos

Resumen: Introducción: La hipercloremia en el paciente neurocrítico es frecuente y se ha asociado con múltiples desenlaces no favorables. Objetivo: Establecer la relación entre el nivel sérico de hipercloremia en el periodo postoperatorio inmediato y la mortalidad a corto plazo en pacientes neuroquirúrgicos posterior a resección de tumoración intracraneal de manera electiva. Material y métodos: Se realizó un estudio retrospectivo, observacional, comparativo, longitudinal en la unidad de terapia intensiva de un hospital de tercer nivel. Se obtuvieron los datos de los pacientes adultos que se sometieron a un procedimiento electivo de neurocirugía para resección de una masa tumoral intracraneal del 1 de enero de 2016 al 31 de diciembre de 2018 y que estuvieron al menos 24 horas en la UCIA en el postoperatorio inmediato. Los pacientes fueron clasificados de acuerdo al nivel más alto de cloro sérico en las primeras 24 horas. El punto de comparación fue la mortalidad a 30 días de la admisión. Resultados: Se incluyeron 122 pacientes, mediana de edad 48.7 años (20-84), 65 hombres (53%). Hipercloremia en 61 pacientes (50%). Los niveles promedio de cloro en la población general fueron de 110.47 ± 4.7 mmol/L. Hubo una prevalencia en todo el grupo de 50% en el periodo postoperatorio inmediato, de los cuales 12 fallecieron durante los siguientes 30 días. Hubo un marcado incremento de los niveles de cloro sérico en el grupo de mortalidad (60%, comparado con el grupo de no mortalidad, 48%) sin lograr una correlación significativa (p = 0.32). No hubo una correlación significativa entre la presencia de hipercloremia como una variable continua (p = 0.35) o categórica en el periodo postoperatorio inmediato y la mortalidad a 30 días. Conclusiones: La hipercloremia sérica en las primeras 24 horas en el grupo postoperatorio neurocrítico no se relaciona de manera significativa a 30 días con la mortalidad.

Abstract: Introduction: Hyperchloremia in neurocritical patients is common and has been associated with multiple unfavorable outcomes. Objective: To establish the relationship between serum level of hyperchloremia and short-term mortality in neurosurgical patients after elective resection of intracranial tumor. Material and methods: A retrospective, observational, comparative, longitudinal study was carried out in the intensive care unit of a tertiary hospital in northern Mexico. Data were obtained from adult patients who underwent an elective neurosurgery procedure for resection of an intracranial tumor mass from January 1,2016 to December 31, 2018 and who spent at least 24 hours postoperatively in the ICU. The patients were classified according to the highest level of serum chloride in the first 24 hours. End point was mortality within 30 days of admission. Results: 122 patients were included, median age was 48.7 years (20-84); 65 males (53%). Hyperchloremia in the first 24 hours after procedure was detected in 61 patients (50%). Twelve (19.6%) subjects showed hyperchloremia and died in the first 30 days after the procedure. Mean chloride level in the whole population was 110.47 ± 4.7 mmol/L. There was a prevalence in the whole group of 50% of hyperchloremia in the immediate post-operative period, of which 12 died during the next 30 day. There was a marked increase in serum chloride levels in the mortality group (12 of 20 cases, 60%) vs the non-mortality group (49 of 102 cases, 48%) without achieving a significant correlation (p = 0.32). There was no significant correlation between the presence of hyperchloremia as a continuous (p = 0.35) or categorical variable in the immediate postoperative period and mortality at 30 days. Conclusions: Serum hyperchloremia in the first 24 hours in the neurocritical postoperative group is not significantly related to mortality at 30 days.

Resumo: Introdução: A hipercloremia em pacientes neurocrítos é comum e tem sido associada a vários desfechos desfavoráveis. Objetivo: Estabelecer a relação entre o nível sérico de hipercloremia no pós-operatório imediato e a mortalidade em curto prazo em pacientes neurocirúrgicos após ressecção eletiva de tumor intracraniano. Material e métodos: Estudo retrospectivo, observacional, comparativo e longitudinal, realizado na unidade de terapia intensiva de um hospital terciário. Os dados foram obtidos de pacientes adultos submetidos a procedimento eletivo de neurocirurgia para ressecção de massa tumoral intracraniana no período de 1o de janeiro de 2016 a 31 de dezembro de 2018 e que passaram pelo menos 24 horas na UTI no pós-operatório imediatamente. Os pacientes foram classificados de acordo com o nível mais alto de cloro sérico nas primeiras 24 horas. O ponto de comparação foi a mortalidade em 30 dias de internação. Resultados: Foram incluídos 122 pacientes, idade média de 48.7 anos (20-84), 65 homens (53%). Hipercloremia em 61 pacientes (50%). Os níveis médios de cloro na população em geral foram 110.47 ± 4.7 mmol/L. Houve prevalência em todo o grupo de 50% no pós-operatório imediato, dos quais 12 faleceram nos 30 dias seguintes. Houve um aumento acentuado nos níveis de cloro sérico no grupo de mortalidade (60%, em comparação com o grupo de não mortalidade, 48%), sem alcançar uma correlação significativa (p = 0.32). Não houve correlação significativa entre a presença de hipercloremia como variável contínua (p = 0.35) ou categórica no pós-operatório imediato e mortalidade em 30 dias. Conclusões: A hipercloremia sérica nas primeiras 24 horas no grupo pós-operatório neurocrítico não está significativamente relacionada com a mortalidade aos 30 dias.

[Smoking parental as risk factor for the development of Neonatal Respiratory Distress Syndrome]. / Tabaquismo paterno como factor de riesgo para el desarrollo de Síndrome de Distrés Respiratorio (SDR) en el recién nacido (RN).

The Respiratory Distress Syndrome (RDS) is one of the most frequent pathologies in the premature neonates and a major cause of morbidity and mortality. The objective of this study was to determine the association between parental smoking and the development of this syndrome. This study was an observational, longitudinal, retrospective, analytical, prolective type, with the neonates in the Neonatal Intensive Care Unit (NICU) of the Hospital Regional Monterrey (HRMI), who developed RDS (cases) and those that do not (controls), during the period January 2012 - April 2015, in both groups were determined the smoking habits of the father and the statistical analysis using SPSS (v. 14). The total sample was 85 RN, of which 46 developed SDR and 39 didn´t develop it, predominantly the genre male (56%). Seventy per cent of the group of parents who denied smoking, their children developed SDR, while 64% of parents who reported smoking, their children did not manifest this syndrome. The p-value was of 0.002, OR = 0.245, with 0.099 to 0.607 range. CONCLUSION: Parental smoking isn´t a risk factor for the development of RDS in the neonates, it could be considered a protective factor.

[Hematologic and molecular response with dasatinib as second-line treatment in chronic myeloid leukemia (CML) with treatment failure]. / Respuesta hematológica y molecular en leucemia mieloide crónica (LMC) con falla a tratamiento con dasatinib como fármaco de segunda línea.

BACKGROUND: Chronic myeloid leukemia is a myeloproliferative disease characterized by the Philadelphia chromosome and with this, the chimeric protein BCR-ABL. The first-line treatment is imatinib, a tyrosine kinase inhibitor, that has showed good results, but with a significant percentage of treatment failure. This failure has led to second-generation tyrosine kinase inhibitors as second-line treatment such as dasatinib. OBJECTIVES: The objective of the study was to evaluate the efficacy of dasatinib as second-line treatment. MATERIAL AND METHODS: Observational, longitudinal, and retrospective study. Patients with diagnosis of chronic myeloid leukemia that presented failure to first-line treatment were included in the present study; the hematologic response was evaluated at 3, 6, and 12 months, and molecular response at 12 months of follow-up after dasatinib treatment was started. RESULTS: Of a total of 14 patients that were included in the study, a response in the white cell count of 84.6% with a mean response at 4.7 months of follow-up was observed; also 84.6% platelet response with a mean response at 4.7 months of follow-up. Molecular response was also evaluated at a 12-month follow-up, achieving a 50% response with a mean response at 11.08 months of follow-up. A survival rate of 80% at a 12-month follow-up was observed. CONCLUSIONS: The use of dasatinib as a second-line treatment is effective in achieving a sustained hematologic response of 84.6% and a molecular response in 50%, also finding a hematologic response without achieving a total molecular response.

[Survival of patients with diffuse large B-cell lymphoma]. / Supervivencia de pacientes con linfoma difuso de células B grandes.

BACKGROUND: The overall survival and relapse-free survival have increased with current chemotherapy in patients with non-lymphoma Hodgkin. A useful tool to evaluate projections is the International Prognostic Index. Our aim was to evaluate the relation between the prognosis established with the International Prognostic Index and the survival obtained in two years by patients with diffuse large B-cell lymphoma. METHODS: An observational, longitudinal, prospective study was carried out. Patients included were those with diagnosis and treated along a year, who, at some point in their evolution, required hospitalization. All the patients received ciclofosfamide, doxorrubicine, vincristine and prednisone; additionally, some of them received rituximab. The follow-up average was 26 months. Survival was estimated with Kaplan-Meier curves. RESULTS: Forty-nine patients were included and classified according to the International Prognostic Index risk. The survival was 90 % for patients with International Prognostic Index low risk, 66.7 % for the patients with intermediate-low risk, 80 % for patients with intermediate-high risk, and 81 % for patients with high risk. The survival for all risk groups was 77.6 %. When we compared the survival of patients with the expected prognosis through the International Prognostic Index, we obtained p = 0.0000. CONCLUSIONS: Two years after diagnosis, the survival of patients with diffuse large B-cell lymphoma in the study was better than the prognosis estimated through the International Prognostic Index, and similar to that reported in American studies.

INTRODUCCIÓN: la quimioterapia actual ha incrementado la supervivencia total y la libre de recaída en los pacientes con linfoma no Hodgkin. Un recurso que permite hacer proyecciones al respecto es el Índice Pronóstico Internacional (IPI). El objetivo del presente análisis fue determinar la correspondencia entre el pronóstico determinado mediante ese índice y la supervivencia obtenida a dos años. MÉTODOS: estudio longitudinal, observacional y prospectivo. Se incluyeron pacientes diagnosticados y tratados durante un año que hubieran requerido hospitalización. Todos recibieron ciclofosfamida-doxorrubicina-vincristina- prednisona, y en algunos casos también rituximab; el seguimiento en promedio fue de 26 meses. La supervivencia se estimó mediante curvas de Kaplan-Meier. RESULTADOS: se incluyeron 49 pacientes, clasificados de acuerdo con el grupo de riesgo determinado mediante el IPI. La supervivencia total fue de 90 % en los pacientes de riesgo bajo, de 66.7 % en los de riesgo intermedio bajo, de 80 % para los de riesgo intermedio alto y de 81 % para los de riesgo alto. La supervivencia global fue de 77.6 %. Se obtuvo p = 0.0000 al realizar la comparación con el pronóstico esperado según el IPI a dos años. CONCLUSIONES: a dos años del diagnóstico, en el hospital analizado la supervivencia de los pacientes con linfoma no Hodgkin difuso de células B grandes fue mejor a la pronosticada para ese mismo periodo mediante el IPI y semejante a la referida en investigaciones norteamericanas.

[Correlation between subjective global assessment and anthropometric and biochemical values in patients with parenteral nutrition]. / Concordancia entre la evaluación global subjetiva y los valores antropométricos y bioquímicos en pacientes con nutrición parenteral.

BACKGROUND: The prevalence of malnutrition in hospitalized patients is high and is associated with increased morbidity and mortality. At present there is no method of nutritional assessment considered of choice to identify nutritional risk. RESULTS: A cross-sectional study. A total of 50 patients who started total parenteral nutrition were included in the study. The prevalence of malnutrition according to the nutritional parameters were: albumin with 39 patients (78%), lymphocyte count 36 patients (72%), body mass index (BMI) 19 patients (38%), Subjective Global Assessment (SGA) 29 patients (58%). The analysis of the subjective global assessment and objective nutritional tools (anthropometric and laboratory) showed that there is moderate agreement between SGA and BMI (Kappa = 0.53), just as SGA and lymphocyte count (k = 0.44), and poor agreement between SGA and albumin (Kappa = 0.38). CONCLUSIONS: There is poor correlation between Subjective Global Assessment and anthropometric and biochemical values in patients with parenteral nutrition.