Frecuencia de virus respiratorios y características clínicas de niños que acuden a un hospital en México / Frequency of respiratory viruses and clinical characteristics in children attending a care center in Mexico City

OBJETIVO. Describir la frecuencia de virus respiratorios y características clínicas en niños con cuadros respiratorios de un hospital de tercer nivel en México. MATERIAL Y MÉTODOS. Se incluyeron niños con diagnóstico de infección respiratoria y un resultado positivo por inmunofluorescencia de enero 2004 a octubre 2006. RESULTADOS. De 986 muestras nasofaríngeas, 138 (14 por ciento) fueron positivas. La frecuencia fue: 80 por ciento virus sincicial respiratorio (VSR), 8 por ciento parainfluenza 1, 5 por ciento parainfluenza3, 2 por ciento adenovirus, 2 por ciento influenza A, 1 por ciento parainfluenza 2 y 1 por ciento influenza B. CONCLUSIONES. La frecuencia de virus respiratorios fue de 14 por ciento. El VSR se identificó asociado con más frecuencia, a neumonía y bronquiolitis en menores de 3 años.

OBJECTIVE. To describe the frequency of respiratory viruses and clinical characteristics in children with respiratory signs and symptoms in a tertiary care center in Mexico. MATERIAL AND METHODS. Patients with a clinical diagnosis of respiratory infection and a positive immunofluorescence result (Light Diagnostics) from January 2004 to October 2006 were included. RESULTS. From the 986 nashopharyngeal samples, 138 (14 percent) were positive by immunofluorescence. The frequency was: 80 percent RSV, 8 percent parainfluenza 1, 5 percent parainfluenza 3, 2 percent adenovirus, 2 percent influenza A, 1 percent parainfluenza 2 and 1 percent influenza B. CONCLUSIONS. Respiratory viruses were detected in 14 percent of samples tested. RSV was the most frequently identified virus and was associated with pneumonia and bronchiolitis in children younger than 3 years old.

[Frequency of respiratory viruses and clinical characteristics in children attending a care center in Mexico City]. / Frecuencia de virus respiratorios y características clínicas de niños que acuden a un hospital en México.

OBJECTIVE: To describe the frequency of respiratory viruses and clinical characteristics in children with respiratory signs and symptoms in a tertiary care center in Mexico. MATERIAL AND METHODS: Patients with a clinical diagnosis of respiratory infection and a positive immunofluorescence result (Light Diagnostics) from January 2004 to October 2006 were included. RESULTS: From the 986 nashopharyngeal samples, 138 (14%) were positive by immunofluorescence. The frequency was: 80% RSV, 8% parainfluenza 1, 5% parainfluenza 3, 2% adenovirus, 2% influenza A, 1% parainfluenza 2 and 1% influenza B. CONCLUSIONS: Respiratory viruses were detected in 14% of samples tested. RSV was the most frequently identified virus and was associated with pneumonia and bronchiolitis in children younger than 3 years old.

Prospective, comprehensive assessment of cardiac troponin T testing after coronary artery bypass graft surgery.

BACKGROUND: The significance and clinical role of cardiac troponin testing after coronary artery bypass grafting remain unclear. METHODS AND RESULTS: Cardiac troponin T (cTnT) was measured during the first 24 hours after coronary artery bypass graft surgery in 847 consecutive patients. Only 17 patients (2.0%) had new Q waves or left bundle-branch block after surgery; however, cTnT elevation was observed in nearly all subjects, with a median cTnT concentration of 1.08 ng/mL overall. Direct predictors of postoperative cTnT values included preoperative myocardial infarction (P<0.001), preoperative intraaortic balloon pump (P<0.001), intraoperative/postoperative intraaortic balloon pump (P<0.001), number of distal anastomoses (P=0.005), bypass time (P<0.001), and number of intraoperative defibrillations (P=0.009), whereas glomerular filtration rate (P<0.001), off-pump coronary artery bypass grafting (P=0.003), and use of warm cardioplegia (P=0.02) were inversely associated with cTnT values. A linear association was seen between cTnT levels and length of stay and ventilator hours, and in an analysis adjusted for the Society for Thoracic Surgery Risk Model, cTnT remained independently prognostic for death (odds ratio, 3.20; P=0.003), death or heart failure (odds ratio, 2.04; P=0.008), death or need for vasopressors (odds ratio, 2.70; P<0.001), and the composite of all 3 (odds ratio, 2.57; P<0.001). In contrast to consensus-endorsed cTnT cut points for postoperative evaluation, a cTnT <1.60 ng/mL had a negative predictive value of 93% to 99% for excluding various post-coronary artery bypass graft surgery complications. CONCLUSIONS: cTnT concentrations after coronary artery bypass graft surgery are nearly universally elevated, are determined by numerous factors, and are independently prognostic for impending postoperative complications when used at appropriate cut points.

Gender differences in the administration of prophylaxis to prevent deep venous thrombosis.

We investigated gender differences in the prescription of prophylaxis against deep vein thrombosis (DVT) in 2,619 patients who developed acute DVT while being hospitalized for reasons other than DVT or were diagnosed with acute DVT as outpatients but who had been hospitalized within 30 days prior to DVT diagnosis. Men were 21% more likely than women to receive prophylaxis (OR 1.21, 95% CI 1.03-1.43; p=0.021) after adjusting for DVT risk factors, including surgery, trauma, prior DVT, age, and cancer.

Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism.

We investigated the efficacy and safety of extended enoxaparin monotherapy in symptomatic patients with acute pulmonary embolism (PE). We randomized 40 patients in a 1:1 allocation to enoxaparin monotherapy (1 mg/kg twice daily for 10-18 days, and then 1.5mg/kg once daily until day 90) (n = 20) or to enoxaparin 1.0 mg/kg twice daily as a bridge to warfarin with a target international normalized ratio of 2.0-3.0 for 90 days (at least 10 doses of enoxaparin overlapping with warfarin for at least 4 days) (n = 20). All patients underwent echocardiography, cardiac troponin I (TnI), and brain natriuretic peptide testing to identify patients with an increased likelihood of adverse clinical outcomes. The end-points were newly diagnosed deep venous thrombosis (DVT) or PE and bleeding events through day 90. In 15 patients on extended enoxaparin therapy, we used repeated measure analysis of variance (ANOVA) to investigate differences in anti-Xa levels obtained at 2, 4, 8 and 12 weeks. The patients' mean age was 52 +/- 17 years; the most common comorbidities were obesity (58%), hypertension (30%), concomitant DVT (30%) and cancer (15%). Twelve (30%) patients had elevated cardiac Tnl >0.1 mg/l and 11 (28%) had moderate or severe right ventricular dysfunction on echocardiography. Ten (25%) patients received thrombolysis with a continuous infusion of 100 mg alteplase prior to randomization. During a 90-day follow-up, one patient from the enoxaparin monotherapy group suffered symptomatic distal DVT; one from the warfarin group had recurrent symptomatic PE (p = 1.0). None of the study patients had major hemorrhage; two warfarin group patients had minor bleeding compared with none in the enoxaparin monotherapy group (p = 0.49). Repeated measure ANOVA did not reveal significant differences in anti-Xa levels over time (p = 0.217). In patients with acute symptomatic PE, extended enoxaparin monotherapy is feasible and warrants further investigation in a large clinical trial.

Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients.

Our objective was to overview the effectiveness of intermittent pneumatic compression (IPC) devices to prevent deep vein thrombosis (DVT) in postoperative patients, using meta-analysis methodology. We searched the Medline, metaRegister of Controlled Trials, and Cochrane database for studies published between 1970 and October 2004. Our inclusion criteria were: 1) randomized controlled trial of IPC versus no prophylaxis, 2) at least 20 patients per group, 3) at least one diagnostic DVT imaging test in all patients, and 4) clinical follow-up for at least the duration of hospitalization. A total of 2,270 patients were included in 15 eligible studies: 1,125 and 1,145 in the IPC and no prophylaxis group, respectively. The included studies formed a total of 16 treatment groups and were conducted in orthopedic (5), general surgical (4),oncologic (3), neurosurgical (3) and urologic (1) patient populations. In comparison to no prophylaxis, IPC devices reduced the risk of DVT by 60% (relative risk 0.40, 95% CI 0.29 - 0.56; p < 0.001). Contemporary randomized trials should be undertaken to test the utility of IPC in hospitalized medical patients as well as combined pharmacological plus IPC prophylaxis in both medical and surgical patients.

Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism.

BACKGROUND: In patients with acute pulmonary embolism (PE), rapid and accurate risk assessment is paramount in selecting the appropriate treatment strategy. Right ventricular (RV) enlargement on chest CT has previously been shown to correlate with an unstable hospital course, but its role as a predictor of death is unknown. METHODS AND RESULTS: We evaluated 431 consecutive patients (mean age, 59+/-16 years; 55% women) with acute PE confirmed by multidetector-row chest CT. With the use of multiplanar reformats of axial CT data, CT 4-chamber (4-CH) views were reconstructed and right and left ventricular dimensions (RV(D), LV(D)) were measured. RV enlargement, defined as RV(D)/LV(D) >0.9, was present in 276 (64.0%; 95% CI, 59.5% to 68.6%) patients. Thirty-day mortality rate was 15.6% (95% CI, 11.3% to 19.9%) in patients with and 7.7% (95% CI, 3.5% to 12.0%) without RV enlargement (log rank, P=0.018). The hazard ratio of RV(D)/LV(D) >0.9 for predicting 30-day death was 3.36 (95% CI, 1.13 to 9.97; P=0.029). On multivariable analysis, RV enlargement predicted 30-day death (hazard ratio, 5.17; 95% CI, 1.63 to 16.35; P=0.005) after adjusting for pneumonia (hazard ratio, 2.95; 95% CI, 1.19 to 3.83; P=0.002), cancer (hazard ratio, 2.13; 95% CI, 1.19 to 3.83; P=0.011), chronic lung disease (hazard ratio, 2.00; 95% CI, 1.04 to 3.86; P=0.039), and age (hazard ratio, 1.03; 95% CI, 1.01 to 1.05; P=0.005). CONCLUSIONS: In patients with acute PE, RV enlargement on reconstructed CT 4-CH view helps predict early death.

Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism.

BACKGROUND: We investigated the prognostic role of right ventricular enlargement on multidetector-row chest CT in acute pulmonary embolism (PE). METHODS AND RESULTS: We studied 63 patients with CT-confirmed PE who underwent echocardiography within the ensuing 24 hours. Adverse clinical events, defined as 30-day mortality or the need for cardiopulmonary resuscitation, mechanical ventilation, pressors, rescue thrombolysis, or surgical embolectomy, were present in 24 patients. We performed off-line CT measurements of right and left ventricular dimensions (RV(D), LV(D)) with axial and 2-dimensional reconstructed 4-chamber (4-CH) views. The proportion of patients with RV(D)/LV(D)>0.9 on the axial view was similar in patients with (70.8%) and those without adverse events (71.8%; P=0.577). In contrast, RV(D)/LV(D)>0.9 on the 4-CH view was more common in patients with (80.3%) than without (51.3%; P=0.015) adverse events. The area under the curve of RV(D)/LV(D) from the axial and 4-CH views for predicting adverse events was 0.667 and 0.753, respectively. Sensitivity and specificity of RV(D)/LV(D)>0.9 for predicting adverse events were 37.5% and 92.3% on the axial view and 83.3% and 48.7% on the reconstructed 4-CH view, respectively. RV(D)/LV(D)>0.9 on the 4-CH view was an independent predictor for adverse events (OR, 4.02; 95% CI, 1.06 to 15.19; P=0.041) when adjusted for age, obesity, cancer, and recent surgery. CONCLUSIONS: Right ventricular enlargement on the reconstructed CT 4-CH views predicts adverse clinical events in patients with acute PE. Ventricular CT measurements obtained from 4-CH views are superior to those from axial views for identifying high-risk patients.