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Background and Objectives: Pulmonary hypertension (PH) is a clinical condition with high mortality rates, particularly in patients over 65. Current guidelines recommend assessing the likelihood of pulmonary hypertension (LPH) using advanced echocardiography before proceeding to right heart catheterization. This study proposed using the common femoral vein (CFV), an accessible vein that reflects right atrial pressure, as an alternative method to assess the high likelihood of pulmonary hypertension (H-LPH). Materials and Methods: This prospective observational study included 175 emergency patients from three hospitals. Ultrasound assessed the pulsed wave Doppler (PW-Doppler) morphology of the CFV. This diagnostic yield for H-LPH was evaluated alongside traditional ultrasound parameters (right-to-left ventricular basal diameter ratio greater than 1 (RV > LV), septal flattening, right ventricular outflow acceleration time (RVOT) of less than 105 ms and/or mesosystolic notching, pulmonary artery diameter greater than the aortic root (AR) diameter or over 25 mm, early pulmonary regurgitation maximum velocity > 2.2 m/s; TAPSE/PASP less than 0.55, inferior vena cava (IVC) diameter over 21 mm with decreased inspiratory collapse, and right atrial (RA) area over 18 cm2). Results: The CFV's PW-Doppler cardiac pattern correlated strongly with H-LPH, showing a sensitivity (Sn) of 72% and a specificity (Sp) of 96%. RA dilation and TAPSE/PASP < 0.55 also played significant diagnostic roles. Conclusions: The CFV's PW-Doppler cardiac pattern is an effective indicator of H-LPH, allowing reliable exclusion of this condition when absent. This approach could simplify initial LPH evaluation in emergency settings or where echocardiographic resources are limited.
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Introduction: Bone and Joint Infections (BJI) have high morbidity. Methicillin resistant Staphylococcus aureus (MRSA) has increased. Culture-based diagnosis has difficult to recovering fastidious bacteria and detecting polymicrobial infections, molecular methods offer a promising improvement for the diagnosis of BJI with reduced time to result. The aim of the study was to determine the correlation between culture results and the Biofire joint infection panel (BJIP) in a cohort of pediatric patients with BJI. Materials and methods: Descriptive study. Patients admitted with probable o confirmed BJI between July 1, 2019 and February 28, 2021 at HOMI. Blood cultures, synovial and bone fluid samples were taken. Samples were kept at -70 °C. On September 2022, the panel was performed. Results: 32 patients were included. The average age was 83m (RIQ: 32-145). 23 (71.8%) patients had a positive culture. The most frequent microorganism were S. aureus 19 (83%), 11/19 (57.9%) Staphylococci isolates were MRSA. 24/32 (75%) were positive by panel, 20 positive detections were concordant with culture, there were 6 additional isolates by panel (2 S. aureus, 2 S. pyogenes, 1 K. kingae and 1 C. albicans), three microorganisms were isolated in culture but not in the panel. (2 S. aureus and 1 S. agalactiae). Two patients with coinfection were detected. All MRSA were detected by culture and panel. In 26 (81.3%) patients the etiology was documented by any method. Conclusion: These results showed a moderate level of agreement between BJIP and culture (κ = 0.47). The panel allowed the detection of fastidious bacteria including K. kingae and polymicrobial samples. There was a very good level of agreement between the panel and culture for the MRSA detection (κ = 1).
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Introducción: El diagnóstico del síndrome de túnel del carpo se basa en los síntomas y signos clínicos del paciente y se apoya en estudios de electrodiagnóstico. Objetivos: Determinar el rendimiento diagnóstico de los signos clínicos de síndrome de túnel del carpo y la evaluación de un nuevo modelo como propuesta diagnóstica. Métodos: Estudio prospectivo de pruebas diagnósticas para síndrome de túnel del carpo en pacientes que asistieron a la consulta de cirugía de mano: Tinel, Phalen, Elevación de manos, y una nueva propuesta que llamaremos Elevación/Phalen, Resultados: Se evaluaron 88 manos en 47 pacientes con un promedio de edad de 45 años. El Tinel fue positivo en 63 (71,59 %), el Phalen en 67 (76,13 %), la Elevación de manos en 69 (78,4 %) y la Elevación/Phalen en 74 (84,09 %). Respecto al patrón establecido para la comparación clínica, los resultados fueron positivos en 71 (80,6 %) y negativos en 17 (19,4 %). El rendimiento clínico de Elevación/Phalen mostró una sensibilidad del 88,8 % y una especificidad de 78,6 %, con un valor predictivo positivo del 95,9 %. Conclusiones: La prueba Elevación/Phalen es equiparable a las pruebas clásicas de Tinel, Phalen y Elevación de manos, por tanto, puede ser utilizada para el diagnóstico clínico del síndrome de túnel del carpo.
Introduction: The diagnosis of carpal tunnel syndrome is based on the patient's clinical signs and symptoms, supported by electrodiagnostic studies. Objectives: To determine the diagnostic performance of the clinical signs of carpal tunnel syndrome and the evaluation of a new model as a diagnostic proposal. Methods: A prospective study was carried out for diagnostic tests for carpal tunnel syndrome in patients who attended the hand surgery consultation: Tinel, Phalen, Elevation of hands, and a new proposal that we will call Elevation/Phalen. Results: Eighty eight (88) hands were evaluated in 47 patients with a mean age of 45 years. Tinel was positive in 63 (71.59%), Phalen in 67 (76.13%), Hand Elevation in 69 (78.4%) and Elevation/Phalen in 74 (84.09%). Regarding the pattern established for clinical comparison, the results were positive in 71 (80.6%) and negative in 17 (19.4%). The clinical performance of Elevation/Phalen showed 88.8% of sensitivity and 78.6% of specificity, with 95.9% of positive predictive value. Conclusions: The Elevation/Phalen test is comparable to the classic Tinel, Phalen and Hand Elevation tests, therefore, it can be used for the clinical diagnosis of carpal tunnel syndrome.
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Debido a la poca tolerancia asociada a su ejecución, numerosos agentes se han usado como sedantes en pacientes sometidos a fibrobroncoscopia. En el siguiente estudio, controlado y doble ciego, se comparó el uso de propofol versus midazolam en dos grupos de veinte pacientes ambulatorios y escogidos al azar. La incidencia de tolerancia pobre fue menor (p<0,05) en el grupo propofol (5 por ciento contra 20 por ciento). La amnesia durante el procedimiento ocurrió con igual frecuencia en ambos grupos. Tampoco hubo diferencia en las variaciones de tensión arterial y frecuencia cardíaca. Los tiempos promedios de recuperación de coincidencia y psicomotriz fueron menores (p<0,05) en el grupo propofol (5,4 y 10,8 minutos contra 11,6 y 21,3 minutos). Los episodios de desaturación fueron más frecuentes en el grupo propofol (40 por ciento contra 10 por ciento), pero no guardaron relación estadística con el grado de sedación y, posiblemente, se deban al procedimiento perse. En conclusión, el propofol resultó mejor que el midazolam en pacientes ambulatorios sometidos a fibrobroncoscopia