Triggering receptor (TREM-1) expressed on myeloid cells predicts bacteremia better than clinical variables in community-acquired pneumonia.

BACKGROUND AND OBJECTIVE: Some clinical variables are associated with bacteremia in patients with community-acquired pneumonia (CAP). The aim of this study was to analyse the accuracy of the soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1) to predict positive blood cultures in comparison with established clinical prognostic variables. METHODS: In addition to collecting clinical and laboratory information, a commercially available immunoassay kit was used to measure the serum sTREM-1 levels on the first day of admit ion in patients with CAP. Receiver operating characteristic (ROC) curves were used to compare the ability of sTREM-1 and commonly used clinical variables to identify bacteremia. RESULTS: Blood cultures yielded a pathogen in 13 (10.4%) out of 124 patient samples. The microorganisms isolated were Streptococcus pneumoniae (11 patients) and Klebsiella pneumoniae (2 patients). The presence of pleuritic chest pain, tachycardia and extreme white cell count (WCC) were associated with bacteremia. However, ROC curve analysis showed an accuracy of sTREM-1 (area under the receiver operating characteristic curve (AUC) 0.84, 95% CI: 0.72-0.95), which was higher than pleuritic chest pain (AUC 0.71, 95% CI: 0.57-0.84), tachycardia (AUC 0.73, 95% CI: 0.58-0.88) and extreme WCC (AUC 0.70, 95% CI: 0.55-0.85) for predicting positive blood cultures. Low admission sTREM-1 serum values had a high negative predictive value for excluding bacteremia (sTREM-1 <120 pg/mL = 98.8%). CONCLUSIONS: This preliminary study suggests that the determination of sTREM-1 serum levels on admission may be more accurate than clinical variables for identifying bacteremic patients.

Estudio Retrospectivo: Histerectomía Abdominal vs Histerectomía Vaginal, Análisis de Complicaciones Hospitalarias. Hospital San Francisco de Quito. Quito - Ecuador, 2014 - 2015 / Retrospective Cohort Research: Abdominal Hysterectomy vs Vaginal Hysterectomy, Analysis of Hospital Complications. San Francisco de Quito Hospital. Quito - Ecuador, 2014 ­ 2015

INTRODUCCIÓN: La histerectomía es la extirpación quirúrgica del útero, cuyas técnicas quirúrgicas han evolucionado a través del tiempo; es una de las cirugías ginecológicas más frecuentes en el mundo. El objetivo del estudio fue evaluar la frecuencia de complicaciones postquirúrgicas por vía de abordaje y correlacionarlas con factores de riesgo. MÉTODOS: Se diseñó un estudio retrospectivo. Se seleccionó al total de mujeres sometidas quirúrgicamente a histerectomía durante los años 2014 y 2015, el universo lo conformó 409 mujeres intervenidas, de las cuales se obtuvo una muestra de 384, en el servicio de Ginecología. El análisis estadístico se realizó en la herramienta estadística SPSS 17.0. En el análisis de los resultados se utilizaron el test de U Mann-Whitney, Chi cuadrado y Riesgo Relativo. RESULTADOS: El promedio de edad fue 85 % con una edad menor a 50 años. El tiempo medio de procedimiento quirúrgico fue 104 minutos, y un tiempo de hospitalización promedio de 2.7 días. Los antecedentes patológicos fueron la cirugía gineco-obstétrica previa 62 %. El 88 % de las histerectomías fueron por la vía abdominal. La incidencia total de complicaciones en general fue del 3.38 %; el 100 % de las complicaciones se presentaron en la histerectomía abdominal. No existió correlación estadística significativa con factores de riesgo como la obesidad (P 0.15 y RR: 0.39). CONCLUSIONES: La histerectomía vaginal tiene menos complicaciones postquirúrgicas, menos días de hospitalización y un menor tiempo quirúrgico comparado con el abordaje de la vía abdominal. Es recomendable realizar más estudios en otros establecimientos de salud en el Ecuador y comparar las diferentes vía de abordaje incluido la vía laparoscópica.

BACKGROUND: Hysterectomy is the surgical removal of the uterus, whose surgical techniques have evolved over time; it is one of the most frequent gynecological surgeries in the world. The objective of the study was to evaluate the frequency of postsurgical complications through theapproach and correlate them with risk factors. METHODS: A retrospective study was designed. The total number of women surgically undergoing hysterectomy was selected during the years 2014 and 2015. The universe consisted of 409 women undergoing surgery, of whom a sample of 384 was obtained at the Gynecology Department. The statistical analysis was realized in the statistical tool SPSS 17.0. In the analysis of the results, U Mann-Whitney test, Chi square and Relative Risk were used. RESULTS: It was obtained that the average age was 85 % with an age under 50 years. The average time of surgical procedure was 104 minutes, and an average hospitalization time of 2.7 days. The pathological antecedents were the gynecological-obstetric surgery previous 62 %. 88 % of the hysterectomies. The total incidence of complications due to hysterectomy in general was 3.38 %; 100 % of complications occurred in abdominal hysterectomy. There was no significant statistical correlation with risk factors such as obesity (P 0.15 and RR: 0.39). CONCLUSIONS: Vaginal hysterectomy has fewer postsurgical complications, less days of hospitalization and a shorter surgical time compared to the abdominal approach; however, abdominal hysterectomy is the most frequent of treatment choice. It is recommendable to realize more studies in other health institutions in Ecuador.

C-reactive protein for discriminating treatment failure from slow responding pneumonia.

BACKGROUND: The management of patients with community-acquired pneumonia (CAP) who fail to improve constitutes a challenge for clinicians. This study investigated the usefulness of C-reactive protein (CRP) changes in discriminating true treatment failure from slow response to treatment. METHODS: This prospective multicenter observational study investigated the behavior of plasma CRP levels on days 1 and 4 in hospitalized patients with CAP. We identified non-responding patients as those who had not reached clinical stability by day 4. Among them, true treatment failure and slow response situations were defined when initial therapy had to be changed or not after day 4 by attending clinicians, respectively. RESULTS: By day 4, 78 (27.4%) out of 285 patients had not reached clinical stability. Among them, 56 (71.8%) patients were cured without changes in initial therapy (mortality 0.0%), and in 22 (28.2%) patients, the initial empirical therapy needed to be changed (mortality 40.9%). By day 4, CRP levels fell in 52 (92.9%) slow responding and only in 7 (31.8%) late treatment failure patients (p<0.001). A model developed including CRP behavior and respiratory rate at day 4 identified treatment failure patients with an area under the Receiver Operating Characteristic curve of 0.87 (CI 95%, 0.78-0.96). CONCLUSION: Changes in CRP levels are useful to discriminate between true treatment failure and slow response to treatment and can help clinicians in management decisions when CAP patients fail to improve.