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INTRODUCTION: Extracranial complications occur commonly in patients with traumatic brain injury (TBI) and can have implications for patient outcome. Patient-specific risk factors for developing these complications are not well studied, particularly in low and middle-income countries (LMIC). The study objective was to determine patient-specific risk factors for development of extracranial complications in TBI. METHODS: We assessed the relationship between patient demographic and injury factors and incidence of extracranial complications using data collected September 2008-October 2011 from the BEST TRIP trial, a randomized controlled trial assessing TBI management protocolized on intracranial pressure (ICP) monitoring versus imaging and clinical exam, and a companion observational patient cohort. RESULTS: Extracranial infections (55%), respiratory complications (19%), hyponatremia (27%), hypernatremia (27%), hospital acquired pressure ulcers (6%), coagulopathy (9%), cardiac arrest (10%), and shock (5%) occurred at a rate of ≥5% in our study population; overall combined rate of these complications was 82.3%. Tracheostomy in the intensive care unit (P < 0.001), tracheostomy timing (P = 0.025), mannitol and hypertonic saline doses (P < 0.001), brain-specific therapy days and brain-specific therapy intensity (P < 0.001), extracranial surgery (P < 0.001), and neuroworsening with pupil asymmetry (P = 0.038) were all significantly related to the development of one of these complications by univariable analysis. Multivariable analysis revealed ICP monitor use and brain-specific therapy intensity to be the most common factors associated with individual complications. CONCLUSIONS: Extracranial complications are common following TBI. ICP monitoring and treatment are related to extra-cranial complications. This supports the need for reassessing the risk-benefit balance of our current management approaches in the interest of improving outcome.
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Resumen Objetivo: Evaluar los atributos de la Atención Primaria de Salud (APS) en cuatro establecimientos de primer nivel de la ciudad de Ayacucho. Material y métodos : Estudio observacional, descriptivo, transversal, realizado entre el 5 y 24 de febrero del 2018. Se utilizó como técnica la entrevista y como instrumento, la guía de la entrevista estructurada Primary Care Assessment Tools versión brasileña corta en español para la evaluación de la Atención Primaria de Salud. Resultados : Los atributos con menores calificaciones de desempeño fueron: Enfoque Familiar, Orientación Comunitaria y Primer Contacto-Accesibilidad; los que tuvieron mejores puntajes fueron: Coordinación, Primer Contacto-Utilización y Globalidad. Existieron múltiples diferencias significativas entre centros de salud excepto en Enfoque Familiar que percibida por todos los centros como deficiente. Conclusiones: El cumplimiento de los atributos de Coordinación-Sistema de Atención, Primer Contacto-Utilización y Globalidad-Servicios recibidos fueron percibidos como los más eficientes; los atributos de Enfoque Familiar, Orientación Comunitaria y Primer Contacto-Utilización fueron percibidos como deficientes.
Summary Objective: To evaluate primary care attributes at the four first level of care centers in Ayacucho, Peru. Methods: a cross-sectional study was carried-out from 5-24 of February, 2018. An interview using the short version of the structured Brazilian Primary Care Assessment Tool translated into Spanish was done. Results: The least qualified attributes were family focus, community orientation and first contact-accessibility, in contrast coordination and first contact-utilization and globality attained the highest qualification. Marked differences were found among the centers with the exception of family focus that was found deficient by all centers. Conclusions: Differences in the attributes were found among the first level centers evaluated.
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La hipercalcemia es un trastorno común que representa aproximadamente el 0,6% de todas las admisiones médicas agudas. El hiperparatiroidismo primario (HPTP) y las neoplasias malignas son las dos causas más comunes de elevación de los niveles séricos de calcio; constituyen, en conjunto, alrededor del 90% de todos los casos. La presentación sintomática clásica de la hipercalcemia se observa con relativa poca frecuencia en el mundo desarrollado; la presentación más común es la detección asintomática en las pruebas bioquímicas. Sin embargo, en casos raros, el HPTP puede desarrollar hipercalcemia aguda, grave y sintomática, llamada crisis hipercalcémica (CH). Esta condición se asocia a alteraciones profundas en el estado mental y las funciones cardíaca, renal y gastrointestinal en presencia de concentraciones marcadamente elevadas de calcio sérico y paratohormona (PTH). Mientras que algunas elevaciones en el calcio sérico pueden ser bien toleradas, los síntomas de la CH son severos. Si el tratamiento se retrasa, la CH puede provocar la muerte. Describimos el caso de un paciente masculino que ingresa en la unidad de cuidados críticos por una CH secundaria a un HPTP por adenoma paratiroideo. (AU)
Hypercalcaemia is a most common disorder, accounting for approximately 0,6% of all acute medical admissions. Primary hyperparathyroidism (PHPT) and malignancy are the two most common causes of increased serum calcium levels, together accounting for about 90% of all cases. The classical symptomatic presentation of hypercalcaemia is seen relatively rarely in the developed world, the most common presentation being asymptomatic and detected following on biochemical testing. However, in rare cases HPTP can result in acute, severe and symptomatic hypercalcemia, called hypercalcemic crisis (HC). This condition is associated with profound disturbances in mental status, and cardiac, renal, and gastrointestinal function in the presence of markedly increased serum calcium and parathyroid hormone (PTH) concentrations. While some elevations in serum calcium can be well tolerated, symptoms of HC are severe. If treatment is delayed, HC can result in death. We describe herein a case of a male patient who was admitted to the intensive care unit as a consequence of HC resulting from elevated PTH, secondary to a parathyroid adenoma. We describe the case of a male patient who was admitted to the critical care unit for a HC mediated by PTH secondary to a parathyroid adenoma. (AU)