[Efecto de la rehabilitación cardiaca temprana en pacientes incluidos en Código Infarto].

Introduction: Early cardiac rehabilitation (ECR) implemented in the Infarction Code (IC) protocol is a strategy in the care of acute myocardial infarction. The purpose of this study was to identify the effect of ECR in IC-included patients. Method: Case-control study. Consecutive patients diagnosed with acute myocardial infarction and admitted to a cardiology hospital between February 2015 and June 2017 were included. Two groups were created: I and II, before and after IC and ECR. Results: We included 1141 patients, 220 in group I and 921 in group II, with an age of 62.64 ± 10.53 years; 80.9 % were males and 19.1 % females. The main risk factors for groups I and II were sedentariness, 92.7 % versus 77.8 %; dyslipidemia, 80.9 % versus 55.8 %; hypertension, 63.2 % versus 62 %; smoking, 66.8 % versus 59.2 %; and diabetes, 54.5 % versus 59.1 %. Rehabilitation was started earlier (1.8 ± 1.6 versus 4.2 ± 3.2) and the days spent in intensive therapy and hospitalization were fewer in group II (2.4 ± 2.2 versus 4.8 ± 4.1 and 8.6 ± 5.2 versus 12.3 ± 7.7, p < 0.0001, respectively), as well as the days of disability (58.6 versus 67.7). Conclusions: IC and ECR are complementary strategies that allow an early discharge from intensive therapy and hospitalization, as well as better quality of life and fewer days of disability leave.

Introducción: La rehabilitación cardiaca temprana (RCT) implementada en el protocolo Código Infarto (CI) es una estrategia en la atención del infarto agudo de miocardio. El objetivo fue identificar el efecto de la RCT en pacientes incluidos en CI. Método: Estudio de casos y controles. Se incluyeron pacientes consecutivos con diagnóstico de infarto agudo de miocardio ingresados a un hospital de cardiología entre febrero de 2015 y junio de 2017. Se crearon dos grupos: I y II, antes y después de CI y RCT. Resultados: Se incluyeron 1141 pacientes: 220 del grupo I y 921 del grupo II, edad 62.64 ± 10.53 años; 80.9 % hombres y 19.1 % mujeres. Los principales factores de riesgo para los grupos I y II fueron sedentarismo, 92.7 y 77.8 %; dislipidemia, 80.9 y 55.8 %; hipertensión, 63.2 y 62 %; tabaquismo, 66.8 y 59.2 %; y diabetes, 54.5 y 59.1 %. En el grupo II se inició antes la rehabilitación (1.8 ± 1.6 y 4.2 ± 3.2) y los días en terapia intensiva y hospitalización fueron menores (2.4 ± 2.2 y 4.8 ± 4.1; 8.6 ± 5.2 y 12.3 ± 7.7), así como los días de incapacidad (58.6 y 67.7). Conclusiones: CI y RCT son estrategias complementarias que permiten alta temprana de terapia intensiva y hospitalización, mejor calidad de vida y menos días de incapacidad laboral.

[Clinical and laboratory parameters in neonatal nosocomial sepsis]. / Parámetros clínicos y de laboratorio asociados a sepsis neonatal nosocomial.

OBJECTIVE: Assess if certain clinical and laboratorial data are associated with Neonatal Nosocomial Sepsis (NNS). METHODS: From March to June 2003, 343 premature neonates (PN) with clinical data suggestive of NNS were recruited; 60 fulfilled the inclusion criteria and were studied. Laboratory tests included two blood cultures from different peripheral veins, complete blood count (CBC), serial C reactive protein (CRP), and buffy coat (BC) smear stained with acridine orange. Clinical data and laboratory test results were compared among neonates with and without pathogenic bacteria isolated in the blood culture. Statistical analysis included chi-square tests (chi2), odds ratios (OR), sensitivity, specificity and predictive values. RESULTS: In 35/60 (58.3%) PN, a pathogenic bacteria was isolated in blood cultures. We did not identify signs and symptoms significantly associated with SNN. Thrombocytopenia (chi2 4.8 d.f. 1; p = 0.03; OR: 3.2, C.I. 95% 1.1-9.6); positive CRP (chi2 9.1 d.f. 1; p = 0.003; OR: 15.1 C.I. 95%. 1.7-130.6), and positive buffy coat smear (chi2 6.7 d.f. 1; p = 0.009; OR: 11 C.I. 95% 1.3-91.9) were associated with NNS. Staphylococcus epidermidis and Serratia marcescens were the most frequent isolated bacteria. CONCLUSIONS: The present study did not identify signs and symptoms associated with NNS. Nevertheless, thrombocytopenia, positive CRP and positive buffy coat smear were considered adequate predictive factors.

[Acute myocardial infarction with ST-segment elevation: Code I]. / Infarto agudo del miocardio con elevación del segmento ST: Código I.

Code infarction is a timely strategy for the treatment of acute myocardial infarction (AMI) with elevation of the ST segment. This strategy has shown an increase in survival and quality of life of patients suffering from this event around the world. The processes of management and disposition aimed at the reduction of time for effective and timely reperfusion are undoubtedly a continuous challenge. In the Instituto Mexicano del Seguro Social (IMSS) the mortality due to AMI has been reduced more than 50%, which is a historical situation that deserves much attention. Nonetheless, the continuous improvement and a wider coverage of this strategy in our country are the key factors that will outline a change in the natural history of the leading cause of death in Mexico. This review focuses on current strategies for the management of patients with acute myocardial infarction.

Código Infarto es una estrategia de manejo oportuno del infarto agudo del miocardio (IAM) con elevación del segmento ST que ha demostrado en todo el mundo un incremento en la sobrevida y calidad de vida de los pacientes que sufren de este evento. Los procesos de gestión y atención oportuna dirigidos a la reducción de tiempo para la reperfusión eficaz y eficiente son sin duda un reto continuo. En el IMSS se ha logrado más del 50% de reducción en la mortalidad, situación histórica que merece mucha atención. Sin embargo, será la mejora continua y la generalización de los servicios a todo el país lo que demarcará un cambio en la historia natural de la primera causa de muerte en nuestro país. Esta revisión se centra en las estrategias actuales del manejo de pacientes con infarto agudo de miocardio.

[Protein C congenital deficiency. A case report]. / Deficiencia congénita de proteína C. Informe de un caso.

Protein C is a plasmatic protein that is synthesized by the liver with the help of vitamin K. It regulates thrombin formation and consequently prevents thrombosis. We present a case of a newborn male with change in the color of the right foot index finger who after 4 h showed cyanosis that reached malleolus level. Upon admission we observed generalized pallor, tachycardia and a necrotic lesion in the rightfoot. We suspected a septic process and thus administered cefotaxime, vancomycin and heparin. Platelet levels were 70,000 mm3, thromboplastin 16/12 sec., partial thromboplastin 5829 sec. PCfunctionality 20% and protein S 100%. Even though the patient evolvedfavourably and showed partial recovery, an intratuberous amputation was needed. One year later a prosthesis was fitted. We need to carry out studies that support the use of PC monoclonal antibodies in order to offer better baseline treatment to patients with PC congenital deficiency and improve their quality of live.

[Cardiac tamponade in the neonate as a complication of a central venous catheter. Case report]. / Taponamiento cardiaco en el neonato como complicación de catéter venoso central. Reporte de casos.

BACKGROUND: Central venous access is a necessity for the critically-ill newborn who arrives at a Neonatal Intensive Care Unit; despite being considered a relatively safe procedure, it may cause to complications with fatal consequences. OBJECTIVE: To describe the course of five newborn patients undergoing cardiac tamponade as a complication of central venous catheter. DESIGN: Case series. MATERIAL AND METHODS: Clinical files of five newborn patients admitted to the NICU who had had central venous catheter installed and underwent cardiac tamponade as a complication were reviewed. Data was collected on a previously designed chart in which identification, venous access, time installed before complication, diagnosis, treatment, and development were registered. RESULTS: Expressions of central tendency and dispersion were used for statistical analysis. Four preterm infants and one term infant were analyzed; mean gestational age was 31.5 weeks. Lapse between installation of centralvenous catheter and appearance of cardiac tamponade was 3 to 12 days, with mean of 6.2 days. The previously mentioned diagnosis was suspected when patients presented sudden hemodynamic dysfunction. Diagnosis was confirmed by echocardiography after resuscitation. Pericardic punction was performed in all patients, but only in four patients was nutrition admixture was obtained. CONCLUSIONS: We consider superior cava vein to be the safest site to place a central venous catheter above right atrium. Its position must periodically be confirmed via x-ray because of risk of migration phenomenom. Pericardic punction should be considered when a patient suddenly requires cardiopulmonary resuscitation and does not respond to common reanimation maneuvers.

Efecto de la rehabilitación cardiaca temprana en pacientes incluidos en Código Infarto / Effect of early cardiac rehabilitation in patients included in Codigo Infarto

Resumen Introducción: La rehabilitación cardiaca temprana (RCT) implementada en el protocolo Código Infarto (CI) es una estrategia en la atención del infarto agudo de miocardio. El objetivo fue identificar el efecto de la RCT en pacientes incluidos en CI. Método: Estudio de casos y controles. Se incluyeron pacientes consecutivos con diagnóstico de infarto agudo de miocardio ingresados a un hospital de cardiología entre febrero de 2015 y junio de 2017. Se crearon dos grupos: I y II, antes y después de CI y RCT. Resultados: Se incluyeron 1141 pacientes: 220 del grupo I y 921 del grupo II, edad 62.64 ± 10.53 años; 80.9 % hombres y 19.1 % mujeres. Los principales factores de riesgo para los grupos I y II fueron sedentarismo, 92.7 y 77.8 %; dislipidemia, 80.9 y 55.8 %; hipertensión, 63.2 y 62 %; tabaquismo, 66.8 y 59.2 %; y diabetes, 54.5 y 59.1 %. En el grupo II se inició antes la rehabilitación (1.8 ± 1.6 y 4.2 ± 3.2) y los días en terapia intensiva y hospitalización fueron menores (2.4 ± 2.2 y 4.8 ± 4.1; 8.6 ± 5.2 y 12.3 ± 7.7), así como los días de incapacidad (58.6 y 67.7). Conclusiones: CI y RCT son estrategias complementarias que permiten alta temprana de terapia intensiva y hospitalización, mejor calidad de vida y menos días de incapacidad laboral.

Abstract Introduction: Early cardiac rehabilitation (ECR) implemented in the Infarction Code (IC) protocol is a strategy in the care of acute myocardial infarction. The purpose of this study was to identify the effect of ECR in IC-included patients. Method: Case-control study. Consecutive patients diagnosed with acute myocardial infarction and admitted to a cardiology hospital between February 2015 and June 2017 were included. Two groups were created: I and II, before and after IC and ECR. Results: We included 1141 patients, 220 in group I and 921 in group II, with an age of 62.64 ± 10.53 years; 80.9 % were males and 19.1 % females. The main risk factors for groups I and II were sedentariness, 92.7 % versus 77.8 %; dyslipidemia, 80.9 % versus 55.8 %; hypertension, 63.2 % versus 62 %; smoking, 66.8 % versus 59.2 %; and diabetes, 54.5 % versus 59.1 %. Rehabilitation was started earlier (1.8 ± 1.6 versus 4.2 ± 3.2) and the days spent in intensive therapy and hospitalization were fewer in group II (2.4 ± 2.2 versus 4.8 ± 4.1 and 8.6 ± 5.2 versus 12.3 ± 7.7, p < 0.0001, respectively), as well as the days of disability (58.6 versus 67.7). Conclusions: IC and ECR are complementary strategies that allow an early discharge from intensive therapy and hospitalization, as well as better quality of life and fewer days of disability leave.

[Adverse events in patients from a pediatric hospital.] / Eventos adversos en pacientes de un hospital pediátrico.

Background: detection of adverse events is part of the safety management in hospitalized patients. The objective of this study was to describe the incidence of adverse events that occurred in a pediatric hospital. Methods: cross-sectional study of the adverse events occurred in a pediatric hospital from 2007 to 2009. Factors associated with their developmental causes were identified. The statistical analysis was descriptive and bivariate, with contingency tables to estimate the relationship between those factors. A p value = 0.05 was considered significant. Results: a total of 177 adverse events were registered. When they began, human factor occurred in 23 cases (13 %, OR = 1.41, p = 0.001), organizational factor was present in 71 cases (40 %, OR = 1.91, p = 0.236) and technical factor in 46 cases (26 %, OR = 0.87, p = 0.01). Blows or bruises from falls as a result of adverse events occurred in 71 cases (40 %, 95 % CI = 64-78). Conclusions: we found 1.84 events per 100 hospital discharges during the study period. The fall of patients ranked first of the adverse events identified.

Introducción: la detección de los eventos adversos es parte de la gestión de la seguridad en los pacientes hospitalizados. El objetivo de este estudio fue describir la incidencia de los eventos adversos ocurridos en un hospital de pediatría del Instituto Mexicano del Seguro Social entre 2007 y 2009. Métodos: estudio transversal analítico de los eventos adversos ocurridos en pacientes pediátricos. El análisis estadístico fue descriptivo y bivariado, con tablas de contingencia para estimar la relación entre los factores. Un valor de p = 0.05 fue significativo. Resultados: se identificaron 177 eventos adversos en el periodo de estudio. En su génesis, el factor humano se relacionó en 23 casos (13 %, RM = 1.41, p = 0.001), el factor organizacional en 71 (40 %, RM = 1.91, p = 0.236) y el factor técnico en 46 (26 %, RM = 0.87, p = 0.01). Las contusiones como consecuencia de las caídas se presentaron en 71 pacientes (40 %, IC 95 % = 64-78). Conclusiones: encontramos 1.84 eventos por cada 100 egresos hospitalarios durante el periodo de estudio. La caída ocupó el primer lugar de los eventos adversos identificados.

Parámetros clínicos y de laboratorio asociados a sepsis neonatal nosocomial / Clinical and laboratory parameters in neonatal nosocomial sepsis

Objetivo: Evaluar la utilidad de signos, síntomas y parámetros laboratoriales para predecir sepsis neonatal nosocomial. Métodos: De marzo de 2002 a junio de 2003 se identificaron 343 recién nacidos con sospecha de sepsis neonatal nosocomial, de los cuales 60 reunieron los criterios de inclusión. Se tomaron dos hemocultivos, biometría hemática, proteína C reactiva (PCR) seriada y un frotis de leucocitos teñidos con naranja de acridina o buffy coat. Los signos clínicos y laboratoriales fueron comparados en neonatos con y sin hemocultivo positivo, mediante χ2. Se calculó sensibilidad, especificidad, valores de predicción y razón de momios. Resultados: En 35/60 (58.3%) recién nacidos se aislaron bacterias patógenas. No se identificaron signos o síntomas asociados a sepsis neonatal nosocomial. Plaquetopenia (χ2=4.8 d.f. 1,p=0.03, RM=3.2, IC 95%=1.1-9.6); PCR positiva inicial (χ2=9.1 d.f. 1, p=0.003, RM=15.1, IC 95%=1.7-130.6) y buffy coat positivo (χ2=6.7 d.f.1,p=0.009, RM=11, IC 95%=1.3-91.9) se asociaron significativamente a sepsis neonatal nosocomial. Staphylococcus epidermidis y Serratia marcescens fueron las bacterias más aisladas. Conclusiones: Nuestros resultados fueron consistentes con otros informes, los signos y síntomas clínicos no son de utilidad para predecir sepsis neonatal nosocomial, mientras que la plaquetopenia, PCR y buffy coat positivos resultaron buenos predictores de esta patología.

OBJECTIVE: Assess if certain clinical and laboratorial data are associated with Neonatal Nosocomial Sepsis (NNS). METHODS: From March to June 2003, 343 premature neonates (PN) with clinical data suggestive of NNS were recruited; 60 fulfilled the inclusion criteria and were studied. Laboratory tests included two blood cultures from different peripheral veins, complete blood count (CBC), serial C reactive protein (CRP), and buffy coat (BC) smear stained with acridine orange. Clinical data and laboratory test results were compared among neonates with and without pathogenic bacteria isolated in the blood culture. Statistical analysis included chi-square tests (chi2), odds ratios (OR), sensitivity, specificity and predictive values. RESULTS: In 35/60 (58.3%) PN, a pathogenic bacteria was isolated in blood cultures. We did not identify signs and symptoms significantly associated with SNN. Thrombocytopenia (chi2 4.8 d.f. 1; p = 0.03; OR: 3.2, C.I. 95% 1.1-9.6); positive CRP (chi2 9.1 d.f. 1; p = 0.003; OR: 15.1 C.I. 95%. 1.7-130.6), and positive buffy coat smear (chi2 6.7 d.f. 1; p = 0.009; OR: 11 C.I. 95% 1.3-91.9) were associated with NNS. Staphylococcus epidermidis and Serratia marcescens were the most frequent isolated bacteria. CONCLUSIONS: The present study did not identify signs and symptoms associated with NNS. Nevertheless, thrombocytopenia, positive CRP and positive buffy coat smear were considered adequate predictive factors.

Deficiencia congénita de proteína C: Informe de un caso / Protein C congenital deficiency: A case report

La proteína C (PC) es una proteína plasmática que se sintetiza en el hígado con el apoyo de la vitamina K y regula la formación de trombina y consecuentemente la prevención de una trombosis. Se presenta el caso de un recién nacido masculino, con cambio de coloración en primer dedo del pie derecho, y 4 h después cianosis hasta nivel maleolar. A su ingreso se encontró con palidez generalizada, taquicárdico y con lesión necrótica en pie derecho. Inicialmente se sospechó proceso séptico por lo cual se manejó con Cefotaxima, Vancomicina y heparina. Presentó plaquetopenia 70,000mm³, tiempo de tromboplastina 16/12 seg. y tiempo de tromboplastina parcial de 58/29 seg., con funcionalidad de PC del 20% y proteína S de 100%. A pesar de mostrar evolución favorable y una recuperación parcial de la zona afectada, requirió amputación infratuberocitaria, además de manejo con enoxaheparina que posteriormente se cambió por acenocumarina, poco después del año de edad, se colocó prótesis. Se discute la conveniencia de continuar con estudios que apoyen el uso de anticuerpos monoclonales de PC a fin de dar el tratamiento sustitutivo de base y mejorar la calidad de vida de pacientes con deficiencia congénita de la misma.

Protein C is a plasmatic protein that is synthesized by the liver with the help of vitamin K. It regulates thrombin formation and consequently prevents thrombosis. We present a case of a newborn male with change in the color of the right foot index finger who after 4 h showed cyanosis that reached malleolus level. Upon admission we observed generalized pallor, tachycardia and a necrotic lesion in the right foot. We suspected a septic process and thus administered cefotaxime, vancomycin and heparin. Platelet levels were 70,000mm³, thromboplastin 16/12 sec., partial thromboplastin 5829 sec. PC functionality 20% and protein S 100%. Even though the patient evolved favourably and showed partial recovery, an intratuberous amputation was needed. One year later a prosthesis was fitted. We need to carry out studies that support the use of PC monoclonal antibodies in order to offer better baseline treatment to patients with PC congenital deficiency and improve their quality of life.

Taponamiento cardiaco en el neonato como complicación de catéter venoso central: Reporte de casos / Cardiac Tamponade in the Neonate As a Complication of a Central Venous Catheter: Case Report

Introducción: el abordaje venoso central es una necesidad para el recién nacido críticamente enfermo que ingresa a la unidad de terapia intensiva neonatal, y aunque es considerado un procedimiento relativamente seguro, puede ocasionar complicaciones de curso fatal. Objetivo: describir cinco casos de recién nacidos que superaron a un evento de taponamiento cardiaco como complicación del uso de un catéter venoso central. Departamento de Neonatología del Hospital de Pediatría del Centro Médico Nacional de Occidente. Diseño: serie de casos. Material y métodos: se revisaron los expedientes clínicos de cinco pacientes recién nacidos, atendidos en la unidad de terapia intensiva neonatal (UTIN), en los que fue colocada una línea venosa central y presentaron como complicación taponamiento cardiaco. Los datos se recabaron en una cédula diseñada para tal fin, en la que se consignaron datos generales, vía de acceso, tiempo de estancia antes de la complicación, método diagnóstico, tratamiento y evolución. Medición de resultados: para su análisis estadístico se usaron medidas de tendencia central y dispersión. Resultados: de los cinco pacientes analizados, uno era de término y cuatro menores de 37 semanas, con edad gestacional promedio de 31.5 semanas, el tiempo transcurrido entre la colocación e la línea venosa central y las manifestaciones del taponamiento cardiaco fue de tres a 12 días con un promedio de 6.2 días, el diagnóstico se sospecho cuando los pacientes presentaron en forma súbita descompensación hemodinámica. Se confirmó el diagnóstico mediante estudio ecocardiográfico, después de resucitación. A todos se les practicó punción pericárdica evacuadora, en cuatro casos se obtuvo mezcla nutricia. Conclusiones: consideramos que el sitio mas seguro del catéter venoso central es en vena cava superior, arriba de atrio derecho, debe verificarse radiológicamente en forma periódica su situación por riesgo de fenómeno de 'migración". La pericardioscentesis debe ser un procedimiento a considerar en un paciente que requiere resucitación cardiopulmonar y no se consiga respuesta a las maniobras habituales de reanimación. Este procedimiento en nuestros casos funcionó como prueba diagnóstico, y puede ser muy útil, sobre todo si no se tiene el recurso apropiado para realizar diagnóstico previo.

Background: central venous access is a necessity for the critically-ill newborn who arrives at a Neonatal Intensive Care Unit; despite being considered a relatively safe procedure, it may cause to complications with fatal consequences. Objective: to describe the course of five newborn patients undergoing cardiac tamponade as a complication of central venous catheter. Design: case series. Material and Methods: clinical files of five newborn patients admitted to the NICU who had had central venous catheter installed and underwent cardiac tamponade as a complication were reviewed. Data was collected on a previously designed chart in which identification, venous access, time installed before complication, diagnosis, treatment, and development were registered. Results: expressions of central tendency and dispersion were used for statistical analysis. Four preterm infants and one term infant were analyzed; meange stationalage was 31.5 weeks. Lapse between installation of central venous catheterand appearance of cardiac tamponade was 3 to 12 days, with mean of 6.2 days. The previously mentioned diagnosis was suspected when patients presented sudden hemodynamic dysfunction. Diagnosis was confirmed by echocardiography after resuscitation. Pericardic punction was performed in all patients, but only in four patients was nutrition admixture was obtained. Conclusions: we consider superior cava vein to be the safest site to place a central venous catheter above right atrium. Its position must periodically be confirmed via x-ray because of risk of migration phenomenom. Pericardic punction should be considered when a patient suddenly requires cardiopulmonary resuscitation and does not respond to common reanimation maneuvers.