Aspiration in the Fiberoptic Endoscopic Evaluation of Swallowing Associated with an Increased Risk of Mortality in a Cohort of Patients Suspected of Oropharyngeal Dysphagia.

There is a general lack of published studies on the risk of mortality due to alterations in the safety of swallowing detected during the fiberoptic endoscopic evaluation of swallowing (FEES). We aimed at assessing the risk of mortality of the detection of aspiration, penetration, and pharyngeal residues by FEES. A cohort of consecutively evaluated patients suspected of experiencing oropharyngeal dysphagia undergoing FEES at a tertiary care university hospital were prospectively followed up on to assess mortality. The FEES findings, comorbidities, and potential confounders were studied as predictors of death using a Cox multivariate regression analysis. A total of 148 patients were included, 85 of whom were male (57.4%). The mean age (± standard deviation) was 52.7 years (± 22.1). The median of the follow-up time was 4.5 years. The most frequent conditions were stroke in 50 patients (33.8%), brain and spine traumas in 27 (18.2%), and neurodegenerative diseases in 19 (12.8%). Variables associated with mortality in bivariate analyses were age > 65 years (p < 0.001), pneumonia (p = 0.046), aspiration of any consistency (p < 0.001), and pharyngeal residues (p = 0.017). Variables independently associated with mortality in the Cox multivariate model were age (> 65 years) [adjusted hazard ratio (HR) 5.76; 95% CI 2.72 to 17.19; p = 0.001] and aspiration (adjusted HR: 3.96; 95% CI 1.82 to 14.64; p = 0.003). Aspiration detected by FEES and an age > 65 years are independent predictors of mortality in patients with oropharyngeal dysphagia.

Comparison of the Diagnostic Performance of Five Clinical Questionnaires for Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) remains one of the most prevalent pathologies in the world and is among the leading causes of mortality and morbidity, partially due to underdiagnosis. The use of clinical questionnaires to identify high-risk individuals to take them to further diagnostic procedures has emerged as a strategy to address this problem. Objective: To compare the performance of the COULD IT BE COPD, CDQ, COPD-PS, LFQ, and PUMA questionnaires for COPD diagnosis. Methods: A cross-sectional study was carried out on subjects who underwent spirometry in the third-level center. Data were collected between January 2015 and March 2020. Bivariate analysis was performed between the study variables and the presence of COPD. The area under the receiver operating characteristics curve (AUC-ROC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for each questionnaire were calculated. The AUC-ROCs were compared with the DeLong test, considering a p value <0.05 statistically significant. Results: 681 subjects met the inclusion criteria and were taken to the final analysis. The prevalence of COPD was 27.5% (187/681). The mean age of the subjects was 65.9 years (SD ± 11.79); 46.3% (315/681) were female, and 83.6% (569/681) reported respiratory symptoms. Statistically significant relationship was found for COPD diagnosis with male sex, older age, respiratory symptoms, and exposure to wood smoke (p value <0.05). The AUC-ROCs of the questionnaires were between 0.581 and 0.681. The COULD IT BE COPD questionnaire had a lower discriminatory capacity AUC-ROC of 0.581, concerning the other scores (DeLong test, p = 0.0002). Conclusion: The CDQ, COPD-PS, LFQ, PUMA, and COULD IT BE COPD questionnaires have acceptable performance for the diagnosis of COPD together with low sensitivity and specificity. Therefore, its use must be complemented with other diagnostic tests or techniques such as pulmonary function tests.

Performance of the CORB (Confusion, Oxygenation, Respiratory Rate, and Blood Pressure) Scale for the Prediction of Clinical Outcomes in Pneumonia.

Background: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality due to misdiagnosis and inappropriate treatment approaches. Objective: To assess the performance of the CORB score in subjects with CAP for predicting in-hospital mortality, death within 30 days of admission, and requirement for invasive mechanical ventilation (IMV) and vasopressor support. Methods: A retrospective, cohort study with diagnostic test analysis of CORB and CURB-65 scores in subjects with CAP according to ATS criteria was undertaken. An alternative CORB score was estimated by replacing SpO2 ≤90% by the SpO2/FiO2 ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a p value <0,05 statistically significant. Results: From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623-0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621-0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589-0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589-0,681) for vasopressor support. CORB performance increases when the SpO2/FiO2 ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654-0,746; p < 0.001) and AUROC of 0,702 (95% CI: 0,66-0,745; p < 0.001), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695-0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695-0,756). Conclusions: CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO2/FiO2 ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. CURB-65 score is superior in the prediction of mortality.

Caracterización de pacientes con síndrome de apnea e hipopnea obstructiva del sueño llevados a Holter electrocardiográfico de 24 horas / Characterisation of patients with obstructive sleep apnoea/hypopnoea syndrome with 24-hour ECG Holter monitoring

Introducción: El síndrome de apnea/hipopnea del sueño se ha asociado a alteraciones en el ritmo cardíaco, sin embargo, en nuestro medio hay pocos datos acerca de las características clínicas y los trastornos del ritmo en sujetos con el síndrome llevados a Holter electrocardiográfico. Métodos: Se desarrolló un estudio descriptivo de serie de casos, con toma de datos de historia clínica, en cuanto a edad, género, antecedentes médicos, ecocardiograma, resultados de polisomnografía y diagnóstico de Holter electrocardiográfico en pacientes con síndrome de apnea/hipopnea obstructiva del sueño en un centro de tercer nivel de atención. Resultados: Se analizaron 149 registros, con edad promedio de 63,01 años (DE: 11,76); 101 pacientes (67,8%) presentaron algún tipo de trastorno del ritmo cardíaco y 86 (57,7%) algún tipo de arritmia. El sexo femenino y la enfermedad pulmonar obstructiva crónica se relacionaron con la presencia de arritmia cardíaca (p < 0,05). Conclusión: En este estudio la presencia de arritmias cardiacas en pacientes con síndrome de apnea/hipopnea obstructiva del sueño llevados a Holter electrocardiográfico, fue de 57,7%; en este sentido, el trastorno más frecuente fueron las extrasístoles ventriculares y contribuyeron con un 28,9%. El sexo femenino y la enfermedad pulmonar obstructiva crónica pueden guardar relación con el incremento de trastornos del ritmo cardíaco en los pacientes con síndrome de apnea/hipopnea obstructiva del sueño. Se requieren estudios analíticos para corroborar estos hallazgos.

Introduction: Sleep apnoea-hypopnoea syndrome has been associated to heart rate alterations; however, in our fields there is few data of the clinical characteristics and heart rate disorders in individuals with this syndrome who have been subject to 24-hours ECG Holter monitoring. Methods: This is a case series descriptive study, with data collection of clinical records including age, gender, medical history, echocardiogram, polysomnography results and ECG Holter monitoring diagnosis in patients with obstructive sleep apnoea hypopnoea syndrome at a third level centre. Results: 149 registers were analysed, with an average age of 63.01 (SD: 11.76); 101 patients (67.8%) showed some kind of heart rate disorder and 86 (57.7%) some type of arrhythmia. Being female and suffering from obstructive pulmonary disease were related to the presence of heart arrhythmia (p < 0.05). Conclusion: In this study the presence of heart arrhythmias in patients with obstructive sleep apnoea hypopnoea syndrome subject to 24-hour ECG Holter monitoring was of 57.7%; the most common disorder were ventricular extrasystoles, which accounted for 28.9%. Being female and suffering from obstructive pulmonary disease could be linked with an increase of heart rate disorders in patients with obstructive sleep apnoea hypopnoea syndrome. Analytical studies are required to corroborate the findings.

Bronquiolitis respiratoria y neumonía descamativa asociada a fungemia por trichosporon asahii en inmunocompetente: a propósito de un caso / Respiratory bronchiolitis and desquamative interstitial pneumonia associated with fungemia by trichosporon asahii in immunocompetent: a case report / Bronquiolite respiratória e pneumonia intersticial desquamativa associada a fungômia por trichosporon asahii em imuno-componente: um relato de caso

Trichosporon asahii es un hongo patógeno emergente reportado en la literatura médica principalmente en pacientes inmunocomprometidos. No obstante, el presente caso es inusual debido a que se trata de un paciente adulto joven inmunocompetente que presentó fungemia por T. asahii y al mismo tiempo desarrolló insuficiencia respiratoria aguda por bronquiolitis respiratoria y neumonía descamativa, la cual resolvió posterior al tratamiento antimicótico instaurado, soporte ventilatorio y vigilancia en Unidad de Cuidado Intesivo (UCI).

Trichosporon asahii is an emerging fungal pathogen reported in the medical literature mainly in immunologically compromised patients. However, this case is unusual because is a young immunocompetent patient who developed fungemia by T. asahii simultaneously with acute respiratory failure, respiratory bronchiolitis and desquamative interstitial pneumonia, who responded satisfactorily to ventilatory support and antifungal therapy.

Trichosporon asahii é um patógeno fúngico emergente relatado na literatura médica principalmente em pacientes imunologicamente comprometidos. No entanto, este caso é incomum porque é um jovem imunocompetente que desenvolveu fungemia por T. asahii simultaneamente com insuficiência respiratória aguda, bronquiolite respiratória e pneumonia intersticial descamativa, que responderam satisfatoriamente ao suporte ventilatório e à terapia antifúngica.

Respiración de Cheyne-Stokes y bruxismo severo documentada por polisomnografía que mejora con la administración de oxígeno a 1 L/min / Cheyne-Stokes respiration and severe bruxism documented by polysomnography that improves with administration of oxygen at 1 L/min

Se presenta el caso de una mujer de 59 años con diagnóstico de encefalopatía anoxicoisquémica, quien se encuentra en estado vegetativo persistente y epilepsia secundaria de difícil control, quien en el transcurso de su evolución clínica desarrolla apnea central del sueño con índice de apnea hipopnea (IAH) de 87.86/h con patrón de respiración de Cheyne-Stokes (RCS) y bruxismo severo documentado mediante polisomnografía, alteraciones que mejoraron tras la administración de oxígeno por cánula nasal a 1 L/min. La asociación de bruxismo con respiración de Cheyne-Stokes y la respuesta simultánea y completa de las dos alteraciones a la administración de oxígeno suplementario no ha sido reportada previamente.

The case of a 59 year old female diagnosed with anoxic-ischemic encephalopathy, who is in a persistent vegetative state and secondary epilepsy difficult to control, who in the course of her clinical evolution develops central sleep apnea with apnea hypopnea index (AHI) of 87.86 / h with Cheyne-Stokes pattern and severe bruxism documented by polysomnography, alterations that improved after administration of oxygen by nasal cannula at 1 L / min., is presented. The association of bruxism with Cheyne-Stokes respiration and the simultaneous and complete response of the two alterations to the administration of supplemental oxygen has not been reported previously.

Síndrome de falla multiorgánica secundario a hematoma esplénico por Plasmodium vivax / Mulitorgan dysfunction syndrome due to splenic hematoma secondary to Plasmodium vivax infection

Los cuadros de falla orgánica múltiple y mortalidad secundarios a Plasmodium vivax son escasos. Generalmente esta infección es considerada un enfermedad de curso benigno. El compromiso esplénico con la formación de hematoma es una complicación poco frecuente por este parásito pero, al presentarse, puede asociarse a un compromiso mayor de los sistemas cardiovascular, respiratorio, hematológico, renal y nervioso central; en algunos casos puede ser fatal. Para el diagnóstico de esta complicación se debe tener una alta sospecha clínica y descartar otras enfermedades, por lo cual presentamos el caso de un paciente quien cursó con un cuadro de hematoma esplénico con falla orgánica múltiple con desenlace fatal por Plasmodium vivax .

Cases of multiple organ failure and mortality secondary to Plasmodium vivax are scarce, and the infection produced by this parasite is generally considered of a benign nature. Splenic compromise with formation of a haematoma is a complication not usually seen; however, when present, it can be associated with a greater compromise of the cardiovascular, respiratory, hematologic, renal and central nervous systems, leading to death in some reports. To diagnose this type of complication, physicians must have a high clinical suspicion and exclude other associated pathologies. We present the case of a patient who developed splenic haematoma associated with multiple organ failure and death secondary to infection with Plasmodium vivax .

Endocarditis bacteriana por Kocuria kristinae en paciente inmunocompetente: Reporte de un caso / Bacterial endocarditis by Kocuria kristinae in an inmunocompetent patient: Case report

Las infecciones por microorganismos del género Kocuria spp. han sido descritas con mayor frecuencia en pacientes con enfermedades crónicas y estados de inmunosupresión. Comúnmente, no se ha reportado su aislamiento como causa de endocarditis en pacientes jóvenes e inmunocompetentes. Se deben diferenciar de las infecciones producidas por Staphylococcus spp. ya que su evolución clínica puede ser similar y sólo el aislamiento y tipifi cación en cultivos permite hacer el diagnóstico etiológico defi nitivo y dirigir la terapia antibiótica adecuada. Se describe el caso de un paciente joven e inmunocompetente que cursó con endocarditis bacteriana, aislándose Kocuria kristinae en hemocultivos.

Infections by microorganisms of the genus Kocuria spp. have been reported more frequently in patients with chronic diseases and immunosuppression. Its isolation has not been reported as cause of endocarditis in young and immunocompetent patients. It should be differentiated from infections caused by Staphylococcus spp. given that their clinical course may be similar and that only the isolation and typification in cultures allows definitive etiologic diagnosis and direct appropriate antibiotic therapy. We describe the case of an immunocompetent young patient who presented bacterial endocarditis and in whose blood cultures kristinae Kocuria was isolated.

Caracterización de pacientes con compromiso pulmonar intersticial asociado a esclerosis sistémica atendidos en el Hospital Militar Central desde enero de 1998 a mayo de 2008 / No presenta

La esclerosis sistémica es una enfermedad clínicamente heterogénea, caracterizada por sobreproducción y depósito de tejido colágeno en piel, órganos internos y pared de vasos sanguíneos. El pronóstico depende en gran parte del compromiso de órganos internos, particularmente el pulmón, siendo éste el segundo órgano más afectado, sólo superado por el esófago. Las dos principales presentaciones clínicas de compromiso pulmonar son la enfermedad pulmonar intersticial y la hipertensión arterial pulmonar, siendo la principal causa de mortalidad en estos pacientes. El objetivo del presente estudio consiste en describir las características clínicas, epidemiológicas, de función pulmonar e imagenológicas del compromiso pulmonar intersticial en pacientes con esclerosis sistémica. Materiales y métodos: revisión de historias clínicas de 112 pacientes con esclerosis sistémica atendidos en el Hospital Militar Central entre enero de 1998 y mayo de 2008. Signos clínicos de compromiso pulmonar, test de función pulmonar, TACAR y BAL fueron utilizados para detectar enfermedad pulmonar intersticial. Resultados: 41 pacientes con esclerosis sistémica presentaron enfermedad pulmonar intersticial por hallazgos tomográficos y por disminución en la capacidad de difusión de monóxido de carbono. El promedio de edad fue de 46 años al inicio de los síntomas de ES. La relación mujer: hombre fue de 9:1. El compromiso pulmonar intersticial fue más frecuente en pacientes con esclerosis sistémica difusa (70%). El síntoma más común fue la disnea (80%). Los ANAS estuvieron presentes en el 100% de los pacientes. La presencia de anti-SLC-70 se asoció con mayor severidad y mayor probabilidad de daño pulmonar. A diferencia de la difusión de monóxido de carbono la espirometría fue normal en un gran porcentaje, teniendo poca utilidad en el diagnóstico inicial. Conclusión: el compromiso pulmonar intersticial asociado a la esclerosis sistémica no es infrecuente en nuestra población, especialmente en pacientes con esclerosis sistémica difusa, sexo femenino y positividad para anti-SCL-70. El diagnóstico temprano de alveolitis es fundamental para prevenir el deterioro en la función pulmonar y reducir la morbimortalidad asociada al compromiso pulmonar. Las herramientas diagnósticas utilizadas para detectar enfermedad pulmonar intersticial son la DLCO, TACAR y BAL. La DLCO es el parámetro de función pulmonar que mejor refleja la presencia de alveolitis. La positividad para el anticuerpo anti-SLC-70 podría estar asociada a mayor severidad y mayor probabilidad de daño pulmonar. La radiografía de tórax tiene menor utilidad que el TACAR en la evaluación de la presencia y extensión de compromiso pulmonar intersticial en ES. Además del TACAR, el BAL con recuento celular diferencial debe ser realizado para diagnosticar alveolitis.

Systemic sclerosis (SSc) is a clinically heterogeneous, systemic disorder which affects the connective tissue of skin, internal organs and the walls of blood vessels. Prognosis of SSc largely depends on involvement of internal organs, particulary the lungs. The frecuency of lung involvement in SSc ranks second to gastrointestinal manifestation. Two major clinical features of lung involvement are interstitial lung disease (ILD) and pulmonary arterial hipertension. Pulmonary complications are the most common causes of death in SSc. The aims of the study was to describe the clinical characteristics, epidemiological, of pulmonary function test and radiological signs of interstitial lung fibrosis in ours patients with SSc. Methods: we reviewed the records of 112 patients with SSc who were seen between 1998 to 2008 at the Hospital Militar Central, Bogota D.C. Clinical signs of pulmonary involvement, Lung Function Tets, High Resolution CT (HRCT) and Bronchoalveolar lavage (BAL) with differential cell counting were used to detect ILD. Results: 41 subjects had SSc asociate to interstitial lung disease as indicated by radiological signs of lung fibrosis by HRCT and decreased carbon monoxide diffusing capacity (DLCO). Women were affected nine times as often as men (9:1). The mean (SD) age of the 46 years (20-79 years). Interstitial lung fibrosis were noticed often in patients with diffuse cutaneous SSc (70%) but less frecuently in patients with limited cutaneous SSc (30%). The most common symptom was dyspnea (80%). Antinuclear antibodies were present in 100% of patients. Antitopoisomerasa I (Scl-70) were found in 57% of patients and in 95% of those with diffuse cutaneous SSc. Unlike the carbon monoxide diffusing, the spirometry was normal in a great percentage, having usefulness small in the early diagnosis. Conclusion: the interstitial lung disease in patients with SSc, is not infrequent in our population, with discharge prevalencia in patients with diffuse cutaneous SSc with Antitopoisomerase I and feminine sex (9:1) in productive ages of the life. Early diagnosis of alveolitis is essential to prevent the deterioration of pulmonary function, improving outcome in SSc patients. Diagnostic procedures used to detect ILD are DLCO, HRCT and BAL. DLCO is the lung function parameter that best reflects the alveolitis in SSc. Chest radiography is less informative than HRCT of the lungs in the evaluation of the presence and extent of ILD in SSc. Antitopoisomerasa I (Scl-70) are associated with interstitial pulmonary disease. In addition to HRCT, BAL with differential cell counting should be performed for diagnosing SSc alveolitis.