Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit.

BACKGROUND: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU. METHODS: The Weill Cornell Medicine Registry and Biobank of Critically Ill Patients is an ongoing cohort of critically ill patients, for whom biological samples and clinical information (including vital signs before and during ICU hospitalization) are prospectively collected. Using such information, qSOFA and SIRS scores outside the ICU (specifically, within 8 hours before ICU admission) were calculated. This study population was therefore comprised of patients in the emergency department or the hospital wards who had suspected infection, were subsequently admitted to the medical ICU and were included in the Registry and Biobank. RESULTS: One hundred fifty-two patients (67% from the emergency department) were included in this study. Sixty-seven percent had positive cultures and 19% died in the hospital. Discrimination of in-hospital mortality using qSOFA [area under the receiver operating characteristic curve (AUC), 0.74; 95% confidence intervals (CI), 0.66-0.81] was significantly greater compared with SIRS criteria (AUC, 0.59; 95% CI, 0.51-0.67; p = 0.03). The qSOFA performed better than SIRS regarding discrimination for ICU-free days (p = 0.04), but not for ventilator-free days (p = 0.19), any organ dysfunction-free days (p = 0.13), or renal dysfunction-free days (p = 0.17). CONCLUSIONS: In patients with suspected infection who eventually required admission to the ICU, qSOFA calculated before their ICU admission had greater accuracy than SIRS for predicting mortality and ICU-free days. However, it may be less clear whether qSOFA is also better than SIRS criteria for predicting ventilator free-days and organ dysfunction-free days. These findings may help clinicians gain further insight into the usefulness of qSOFA.

Caracterización epidemiológica de pacientes con uveítis en el suroccidente colombiano / Epidemiological characterization of patients with uveitis in southwestern Colombia

Introducción: La etnicidad y la geografía se han descrito como determinantes de la presentación clínica de la uveítis y su etiología. Objetivo: Caracterizara los pacientes del suroccidente colombiano con uveítis. Material y métodos: Estudio retrospectivo, del 2011 al 2019, en Cali, Colombia. Se evaluaron características demográficas, clínicas, etiológicas y desenlaces de pacientes con uveítis. Resultados: Se incluyeron 144 pacientes. La edad fue 51.5 (35.2-61.7) años, 80 (55.5%) fueron mujeres. El 66% (n = 95) presentó uveítis anterior. De las manifestaciones clínicas, el ojo rojo fue la más frecuente, seguido de dolor ocular. La mayoría tuvo síntomas < 12 semanas, presentó agudeza visual de 20/20-20/40 y rangos de presión intraocular entre 10 y 22 mmHg. De las etiologías, 20 (17.9%) continuaban en estudio y 7 (6.3%) fueron no definidas/idiopáticas. Trauma se vio en 12 (10.7%), la asociada a HLA-B27 en 10 (8.9%) y toxoplasmosis en 8 (7.1%). Conclusión: Es la primera caracterización de la uveítis en el suroccidente colombiano

Background: Ethnicity and geography have been described as determinants of the clinical presentation of uveitis and its etiology. Objective: To characterize patients from southwestern Colombia with uveitis. Material and methods: Retrospective study, from 2011 to 2019, in Cali, Colombia. Demographic, clinical, etiological characteristics and outcomes of patients with uveitis were evaluated. Results: 144 patients were included. The age was 51.5 (35.2-61.7) years, 80 (55.5%) were women. 66% (n = 95) presented anterior uveitis. Of the clinical manifestations, the red eye was the most frequent, followed by ocular pain. Most had symptoms < 12 weeks, visual acuity of 20/20-20/40 and intraocular pressure ranges between 10-22 mmHg. Of the etiologies, 20 (17.9%) were still under study and 7 (6.3%) were undefined/idiopathic. Trauma was seen in 12 (10.7%), that associated with HLA-B27 in 10 (8.9%) and toxoplasmosis in 8 (7.1%). Conclusion: It is the first characterization of uveitis in southwestern Colombia.

Enfermedad inflamatoria pélvica por Actinomyces y Síndrome de inmunodeficiencia adquirida (SIDA) / Pelvic inflammatory disease from Actinomyces and acquired immunodeficiency syndrome (AIDS)

La enfermedad inflamatoria pélvica en la actualidad debe sospecharse en toda mujer en edad fértil y sexualmente activa, es más frecuente y agresiva en la adolescencia. El actinomyces iraelli posee formas de presentación disimiles, lo que entorpece su diagnóstico, llega a la formación de abscesos con expansión física de un órgano encapsulado. El sida, enfermedad inmunodepresora, es capaz de facilitar y enmascarar cualquier proceso infeccioso, por lo que ante las dos circunstancias anteriores debemos pensar en esta posibilidad diagnóstica. El caso que presentamos comienza con una pequeña tumoración que después se agranda, acompañada de un cortejo sintomático respiratorio, vaso oclusivo y toma del estado general, se realiza el diagnóstico presuntivo y se impone tratamiento para el actinomyces, mejorando abruptamente toda sintomatología, llega más tarde el diagnóstico de ser portador del sida. Conclusión: siempre debemos sospechar ante una enfermedad inflamatoria pélvica en cualquiera de sus formas clínicas, la presencia del actinomyces como uno de los posibles gérmenes causales, sobre todo en pacientes con enfermedades inmunosupresoras como el sida

The pelvic inflammatory illness at the present time debit side to suspect in all woman in fertile and sexually active age, being more frequent and more aggressive in the adolescence The actinomyces iraelli possesses forms of presentation dissimilar, what hinders its diagnosis arriving to the formation of abscesses with physical expansion of an encapsulated organ. The AIDS illness inmunodepresora, is able to mask any infectious process, for what we should think of this diagnostic possibility before the 2 previous circumstances. the case that we present begins with a small tumor that later enlarges, accompanied by a breathing symptomatic retinue, occulsive glass and taking of the general state, he/she is carried out the I diagnose presumptive and empiric treatment is imposed for the actinomyces, improving all sintomatología abruptly, arriving but it takes the I diagnose of being carrier of the AIDS. Conclusion: we should. Always suspect before any Pelvic Inflammatory Illness in anyone in their clinical ways the presence of illnesses inmunosupresoras like the AIDS and the presence of the actinomyces inside their causal germs

Câncer de esôfago: perfil das manifestações clínicas, histologia, localização e comportamento metastático em pacientes submetidos a tratamento oncológico em um centro de referência em Minas Gerais / Esophageal cancer: profile of clinical manifestations, histology, location and metastatic behavior in patients undergoing cancer treatment at a cancer center in Minas Gerais

O câncer de esôfago (CE) é uma neoplasia com uma incidência crescente, com taxas de mortalidade próximas às taxas de incidência. Sua etiologia está associada ao tipo histológico da doença, sendo o carcinoma de células escamosas o mais comum e fortemente relacionado ao tabagismo e etilismo, e o adenocarcinoma associado ao esôfago deBarrett. Além desses fatores sabidamente conhecidos, o risco de desenvolver este tumor está aumentado em pessoasque ingerem alimentos e bebidas quentes (mate) e que possuem nutrição deficiente (hipovitaminose A, C e E); hátambém uma predisposição genética que ainda é pouco definida. Manifestações clínicas comuns durante a evoluçãodessa doença incluem: disfagia, odinofagia, desconforto retroesternal, hiporexia, náusea, vômitos, emagrecimento.Tais queixas merecem uma avaliação criteriosa, pois, quando essas se manifestam, a doença já se encontra, na maioria das vezes, em um estágio avançado, não sendo possível uma abordagem curativa destes pacientes. Os protocolos de tratamento do CE incluem cirurgia, quimioterapia e radioterapia, mas o melhor tratamento ainda é motivo de estudos. Este trabalho teve como objetivo descrever e analisar o perfil das manifestações clínicas, a relaçãoentre o tipo histológico e a localização, idade e comportamento metastático e terapêutica, de pacientes portadores deCE submetidos a tratamento oncológico no Centro de Oncologia e Radioisótopos (COR), Ipatinga-MG. Foi feita análise retrospectiva dos prontuários de 109 pacientes com diagnóstico de CE, de maio de 2004 a fevereiro de 2007. Para cálculos estatísticos, foi utilizado o programa Epi Info 6.04d.