Obesity and the obesity paradox in patients with severe COVID-19.

OBJECTIVE: To test the presence of the obesity paradox in two cohorts of patients hospitalized for COVID-19. DESIGN: Two multicenter prospective cohorts. SETTING: Three fourth level institutions. PATIENTS: Adults hospitalized in the general ward for confirmed COVID-19 in the three institutions and those admitted to one of the 9 critical care units of one of the institutions. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Categorized weight and its relationship with admission to the ICU in hospitalized patients and death in the ICU. RESULT: Of 402 hospitalized patients, 30.1% were obese. Of these, 36.1% were admitted to the ICU vs. 27.1% of non-obese patients. Of the 302 ICU patients, 46.4% were obese. Of these, mortality was 45.0% vs. 52.5% for non-obese. The requirement to transfer hospitalized patients to the ICU admission get a HR of 1.47 (95%CI 0.87-2.51, p = 0.154) in the multivariate analysis. In intensive care patients, an HR of 0.99 (95%CI: 0.92-1.07, p = 0.806) was obtained to the association of obesity with mortality. CONCLUSIONS: The present study does not demonstrate an association between obesity and risk of inpatient transfer to intensive care or death of intensive care patients due to COVID-19 therefore, the presence of an obesity paradox is not confirmed.

High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study. / Troponina de alta sensibilidade no prognóstico de pacientes internados em terapia intensiva por COVID-19: um estudo de coorte longitudinal latino-americano.

OBJECTIVE: The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care. METHODS: A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality. RESULTS: A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12. CONCLUSION: Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.

OBJETIVO: O presente estudo avaliou a prevalência da elevação da troponina e sua capacidade de prever a mortalidade em 60 dias em pacientes com COVID-19 internados em unidade de terapia intensiva. METÓDOS: Um estudo longitudinal prospectivo e unicêntrico foi realizado em uma coorte de pacientes em terapia intensiva devido a diagnóstico de COVID-19 confirmado, usando teste de reação em cadeia da polimerase em tempo real de maio a dezembro de 2020. Uma curva Característica de Operação do Receptor foi construída para predizer o óbito de acordo com o nível de troponina, calculando a área sob a curva e seus intervalos de confiança. Um modelo de risco proporcional de Cox foi gerado para relatar as razões de risco com intervalo de confiança de 95% e o valor de p para sua associação com mortalidade em 60 dias. RESULTADOS: Foram incluídos 296 pacientes com taxa de mortalidade em 60 dias de 51%. A troponina foi positiva em 39,9% (29,6% versus 49,7% em sobreviventes e não sobreviventes, respectivamente). Foi encontrada área sob a curva de 0,65 (IC95% 0,59 - 0,71) para prever a mortalidade. O modelo univariado de Cox demonstrou razão de risco de 1,94 (IC95% 1,41 - 2,67) e p < 0,001, mas essa relação não se manteve no modelo de análise multivariado, no qual a razão de risco foi de 1,387 (IC95% 0,21 - 1,56) e o valor de p foi de 0,12. CONCLUSÃO: A elevação da troponina é frequentemente encontrada em pacientes em terapia intensiva para COVID-19. Embora seus níveis sejam maiores em pacientes que vão a óbito, nenhuma relação foi encontrada em um modelo de análise multivariado, o que indica que a troponina não deve ser utilizada como único marcador prognóstico de mortalidade nessa população.

Troponina de alta sensibilidade no prognóstico de pacientes internados em terapia intensiva por COVID-19: um estudo de coorte longitudinal latino-americano / High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study

RESUMO Objetivo: O presente estudo avaliou a prevalência da elevação da troponina e sua capacidade de prever a mortalidade em 60 dias em pacientes com COVID-19 internados em unidade de terapia intensiva. Metódos: Um estudo longitudinal prospectivo e unicêntrico foi realizado em uma coorte de pacientes em terapia intensiva devido a diagnóstico de COVID-19 confirmado, usando teste de reação em cadeia da polimerase em tempo real de maio a dezembro de 2020. Uma curva Característica de Operação do Receptor foi construída para predizer o óbito de acordo com o nível de troponina, calculando a área sob a curva e seus intervalos de confiança. Um modelo de risco proporcional de Cox foi gerado para relatar as razões de risco com intervalo de confiança de 95% e o valor de p para sua associação com mortalidade em 60 dias. Resultados: Foram incluídos 296 pacientes com taxa de mortalidade em 60 dias de 51%. A troponina foi positiva em 39,9% (29,6% versus 49,7% em sobreviventes e não sobreviventes, respectivamente). Foi encontrada área sob a curva de 0,65 (IC95% 0,59 - 0,71) para prever a mortalidade. O modelo univariado de Cox demonstrou razão de risco de 1,94 (IC95% 1,41 - 2,67) e p < 0,001, mas essa relação não se manteve no modelo de análise multivariado, no qual a razão de risco foi de 1,387 (IC95% 0,21 - 1,56) e o valor de p foi de 0,12. Conclusão: A elevação da troponina é frequentemente encontrada em pacientes em terapia intensiva para COVID-19. Embora seus níveis sejam maiores em pacientes que vão a óbito, nenhuma relação foi encontrada em um modelo de análise multivariado, o que indica que a troponina não deve ser utilizada como único marcador prognóstico de mortalidade nessa população.

ABSTRACT Objective: The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care. Methods: A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality. Results: A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12. Conclusion: Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.

Echocardiographic 60-day mortality markers in patients hospitalized in intensive care for COVID-19.

BACKGROUND: Coronavirus disease COVID-19 produces a predominantly pulmonary affection, being cardiac involvement an important component of the multiorganic dysfunction. At the moment there are few reports about the behavior of echocardiographic images in the patients who have the severe forms of the disease. OBJECTIVE: Identify the echocardiographic prognostic markers for death within 60 days in patients hospitalized in intensive care. METHODS: A single-center prospective cohort was made with patients hospitalized in intensive care for COVID-19 confirmed via polymerase chain reaction who got an echocardiogram between May and October 2020. A Cox multivariate model was plotted reporting the HR and confidence intervals with their respective p values for clinical and echocardiographic variables. RESULTS: Out of the 326 patients included, 153 patients got an echocardiogram performed on average 6.8 days after admission. The average age was 60.7, 47 patients (30.7%) were females and 67 (44.7%) registered positive troponin. 91 patients (59.5%) died. The univariate analysis identified TAPSE, LVEF, pulmonary artery systolic pressure, acute cor pulmonale, right ventricle diastolic dysfunction, and right ventricular dilatation as variables associated with mortality. The multivariate model identified that the acute cor pulmonale with HR= 4.05 (CI 95% 1.09 - 15.02, p 0.037), the right ventricular dilatation with HR= 3.33 (CI 95% 1.29 - 8.61, p 0.013), and LVEF with HR= 0.94 (CI 95% 0.89 - 0.99, p 0.020) were associated with mortality within 60 days. CONCLUSIONS: In patients hospitalized in the intensive care unit for COVID-19, the LVEF, acute cor pulmonale and right ventricular dilatation are prognostic echocardiographic markers associated with death within 60 days.

Effectiveness of emotional freedom techniques with a recreational plastic expression program in postraumatic stress of school age children boarded for abuse-related trauma / Eficacia de un programa de técnicas de libertad emocional con expresión plástica recreativa en el estrés postraumático de escolares internados por maltrato

Abstract We present an experimentally controlled and randomized investigation with pre- and post-trial results, carried out on 47 children boarded for abuse-related trauma in four different shelters. A gradual scale was utilized based on the DSM-5 criteria for post-traumatic stress disorder (PTSD). The program included six sessions that implemented Emotional Freedom Techniques (EFT), together with recreational plastic expression. The Plastic Expression was appropriate, considering the under-developed verbal skills and the hypoactivation of the speech area under the PTSD, and it facilitated the approach of memories in a safe, group-oriented environment. The recreational usage brought along the comfort which in turn helped to counteract the avoidance present at the onset of the PTSD. The EFT gave way to a rapid decrease in the distress response and contributed to the immediate elaboration of memories. The program significantly decreased the level of the PTSD, facilitated learning of new and effective forms of coping, and contributed by opening the mind towards a personal life project.

Resumen Presentamos una investigación experimental controlada y aleatorizada con pre y pos-prueba, llevada a cabo en 47 niños internados por maltrato en cuatro centros de protección. Se utilizó una escala graduada según los criterios del DSM-5 para el trastorno de estrés postraumático (TEPT). El programa comprendió seis sesiones que implementaron Técnicas de Liberación Emocional (EFT) junto con expresión plástica recreativa. La Expresión Plástica fue apropiada, considerando las habilidades verbales en desarrollo y la hipoactivación del área del lenguaje del TEPT, y facilitó la aproximación a tos recuerdos en un entorno seguro y grupal. La recreación brindó bienestar que ayudó a contrarrestar la evitación que está en la génesis del TEPT. La EFT produjo una rápida disminución de la respuesta de alarma y contribuyó a la pronta elaboración del recuerdo. El Programa disminuyó significativamente el nivel del TEPT, facilitó el aprendizaje de nuevas formas eficaces de afrontamiento y aportó al pensamiento de un proyecto de vida personal.

Técnica mínimamente invasiva para correción de pectus carinatum y excavatum. Hospital Infantil Universitario de San José / Minimally invasive technique to correct pectus carinatum and excavatum. Hospital Infantil Universitario de San José

Las deformidades congénitas más frecuentes de la pared torácica son pectus excavatum (TI), pectus carinatum (TQ) y esternón hendido, cuyo tratamiento es quirúrgico. Objetivo: describir la técnica de la cirugía mínimamente invasiva para la corrección de los dos primeros defectos y la experiencia en el Hospital Infantil Universitario de San José Bogotá DC, de 2008 a 2011. Materiales y métodos: reporte de nueve pacientes con pectus carinatum y pectus excavatum, evaluación prequirúrgica, intervención quirúrgica y valoración postquirúrgica, analizando los resultados funcionales y estéticos, con seguimiento de doce meses. Resultados: edad promedio 10.8 años (DE: 1,2 años), cinco hombres, cuatro mujeres; seis pectus excavatum y tres pectus carinatum. En promedio el índice de Haller fue 3,75 (DE: 0,5), el tiempo operatorio 173 minutos (DE: 51,9 min) y la estancia hospitalaria cinco días (DE: 3,6). Hubo una complicación: (desplazamiento de la barra) y en el seguimiento los pacientes estuvieron asintomáticos y satisfechos con el tratamiento. Conclusiones: la experiencia muestra reducción del tiempo operatorio y de la estancia hospitalaria, con complicaciones menores y resultados clínicopsicológicos satisfactorios...

The most frequent congenital thoracic wall deformities are pectus excavatum (PE), pectus carinatum (PC) and sternal clefts, in which surgical treatment is recommended. Objective: to describe the minimally invasive surgical technique used to correct the first two deformities named and experience on patients operated on by this technique at Hospital Infantil Universitario de San José Bogotá DC, from 2008 to 2011. Materials and Methods: report on nine patients with pectus carinatum and pectus excavatum, preoperative evaluation, surgical procedure and post-operative evaluation analyzing functional and aesthetic results through a 12-month follow-up. Results: mean age 10.8 years (SD: 1.2 years), five males, four females; six pectus excavatum and three pectus carinatum. The mean Haller index was 3.75 (SD: 0.5), operating time: 173 minutes (SD: 51.9 min) and hospital stay: five days (SD: 3.6). There was one complication: (bar displacement) and patients were asymptomatic and satisfied with the treatment at follow-up. Conclusions: experience shows reduction of length of operating time and hospital stay with minor complications and satisfactory clinical and psychological results...