Clinical characteristics and comorbidities associated with mortality in patients with COVID-19 in Coahuila (Mexico).

BACKGROUND AND OBJECTIVE: This study aims to describe the characteristics of patients with COVID-19 in a state in northern Mexico and establish the comorbidities associated with mortality. METHODS: Patients with COVID-19, divided into survivors and non-survivors, were analyzed. The data were analyzed using the chi-square test, Student's t-test, and Cox's regression model. RESULTS: A total of 17,479 patients were included and mortality rate of 6.3% was reported. Age over 60 years (HR = 8.04; 95%CI 7.03-9.19), diabetes (HR = 1.63; 95%CI 1.40-1.89), high blood pressure (HR = 1.48; 95%CI 1.28-1.72), obesity (HR = 1.37; 95%CI 1.18-1.60) and chronic kidney disease (HR = 2.06; 95%CI 1.64-2.59) were significantly associated with mortality. CONCLUSIONS: Diabetes, high blood pressure, obesity, and chronic kidney disease increased mortality among patients with COVID-19 in the population of Coahuila, Mexico. The factor that most contributed to risk of death was age over 60 years.

[Clinical characteristics and comorbidities associated with mortality in patients with COVID-19 in Coahuila (Mexico)]. / Características clínicas y comorbilidades asociadas a mortalidad en pacientes con COVID-19 en Coahuila (México).

Background and objective: This study aims to describe the characteristics of patients with COVID-19 in a state in northern Mexico and establish the comorbidities associated with mortality. Methods: Patients with COVID-19, divided into survivors and non-survivors, were analyzed. The data were analyzed using the chi-square test, Student's t-test, and Cox's regression model. Results: A total of 17,479 patients were included and mortality rate of 6.3% was reported. Age over 60 years (HR = 8.04; 95% CI 7.03-9.19), diabetes (HR = 1.63; 95% CI 1.40-1.89), high blood pressure (HR = 1.48; 95% CI 1.28-1.72), obesity (HR = 1.37; 95% CI 1.18-1.60) and chronic kidney disease (HR = 2.06; 95% CI 1.64-2.59) were significantly associated with mortality. Conclusions: Diabetes, high blood pressure, obesity, and chronic kidney disease increased mortality among patients with COVID-19 in the population of Coahuila, Mexico. The factor that most contributed to risk of death was age over 60 years.

[Laparoscopic management of gastroesophageal reflux disease. Experience with 100 cases]. / Manejo laparoscópico de la enfermedad por reflujo gastroesofágico. Experiencia en 100 casos.

OBJECTIVE: To evaluate the results of laparoscopic Nissen-Rossetti funduplication and to compare them with the results obtained in open surgery. DESIGN: Prospective, observational, longitudinal, pre and post-procedure. CENTERS: Beneficencia Española, Hospital Angeles, and Hospital Francisco Galindo Chávez, ISSSTE, in Torreón, Coahuila, Mexico. PATIENTS AND METHOD: From December 1992 to February 1999, 100 patients with surgical indications due to gastroesophageal reflux disease (GERD) prospectively underwent a laparoscopic Nissen-Rossetti procedure. A clinical and endoscopic follow up from 3 months to 9 years was performed in 87 cases. RESULTS: Symptomatic control was achieved in 98% (85/87) of the cases and remission of overall endoscopic esophagitis in 79% (69/87); excluding Barrett cases, esophagitis remission was observed in 93% (67/72) of the subjects. The following recurrences took place: two with G-II and two with G-III esophagitis, one requiring pyloroplasty due gastric stasis, and other patient with G-IV esophagitis, who has needed to continue with postoperative dilations. Of 16 cases with Barrett's esophagus, two-showed remission and one did not return control. Perioperative complications included gastric perforations (3), acute pulmonary edema during the immediate postoperative period (1), deep vein thrombosis (1), and late esophageal perforation (1). All were resolved satisfactorily. Surgical mortality was 0 in the 100 cases undergoing the procedure. Eighty-six percent of cases had a 24-h hospital stay. Early morbidity: dysphagia in 60 patients, early satiety in 91 cases, abdominal distention in 25 cases, all this symptomatology disappears during the subsequent 3 months. Persistent morbidity: flatulence in 60% of patients, difficulty for vomiting in 10% of cases. CONCLUSION: The laparoscopic procedure is as effective as the open method with the advantage of being minimally invasive.

[Laparoscopic cholecystectomy. Analysis of 50 cases]. / Colecistectomía laparoscópica. Análisis de 50 casos.

Biliary lithiasis is considered a significant health problem. Traditionally open cholecystectomy has been considered the gold standard procedure for symptomatic cholecystitis. Laparoscopic cholecystectomy has recently emerged as an alternative, but its usefulness in community hospitals is still being evaluated. Herein we reported our experience in 50 patients treated for 7 months (August of 1991, to February of 1992) by laparoscopic cholecystectomy. It has been necessary to convert one case into an open surgery. There has been no mortality. Seven patients developed right shoulder pain postoperative, it was controlled with minor non addictive analgesics. One had umbilical hematoma, another patient had a superficial phlebitis, and another one developed urinary retention. 43 patients (86%) had had 12 to 24 h hospital stancy, and were back to their normal activities in 7 days; during a 7 months follow-up no complications have been reported. We concluded that laparoscopic cholecystectomy is a safe procedure and can be done by the average general surgeon in community hospitals in a selected patient population. However, we strongly support a continuous monitoring of a protocol for patient management for record-keeping-purposes and as an educational tool.

[Pancreatic resections at general hospitals in Torreon, Coahuila]. / Resecciones pancreáticas en hospitales generales de Torreón, Coahuila.

A retrospective study of nine patients with pancreato-biliary neoplasias were operated in several general hospitals in Torreon, Mexico. Six had pancreatic adenocarcinoma, two ampullary carcinoma and one with common bile duct benign adenoma. We had a morbidity of 55% (5/9); three cases with pancreatic fistula (resolved with nutritional support and general measures) two had obstruction of gastricyeyuno anastomosis (one required surgical management). One patient (11%) died of massive pulmonary embolism. We have now the possibility to perform an earlier diagnosis with update invasive and non invasive diagnostic studies such ERCP, computed tomography and angiography. We are proud to have in our hospitals, intensive care units and well trained surgeons that allow us to perform such kind of specialized surgery.

[Selective distal splenorenal shunt, surgery for portal hypertension. Experience of a general hospital]. / Derivación esplenorenal distal selectiva, cirugía de la hipertensión portal. Experiencia de un hospital general.

From 1982 to 1987, twenty patients underwent Distal Splenorenal Shunt. The surgical indication was hemorrhagic portal hypertension: two cases were done on an emergency basis and eighteen electively. In all patients endoscopy was performed, and the bleeding site was documented; splenoportography was done to 70% and the remaining had selective arteriography with venous phase. Portal pressure was measured during splenoportography or during the operation with catheterization of the right gastroepiploic vein. We had a preoperative histopathologic diagnosis in 60% of the cases. The overall preoperative mortality was 10%, with ascites in seven patients, pancreatic pseudocyst in one, chylous retrogastric collection in one and, encephalopathy in one case. The predicted overall survival for a 5-year period is 77%. We think this surgery can be done in the general hospitals of small cities.