RESUMEN
OBJECTIVE: To describe a Covid-19 outbreak in a gerontological center in Mexico City. MATERIAL AND METHODS: Cross-sectional study in older adults. The association of risk factors for dying from Covid-19 was analyzed using a multiple logistic regression model. RESULTS: One hundred and two elders with an average age of 82.5 ± 8.8 years were included. Fifty-five (54%) tested positive and 47 (46%) were negative for the new coronavirus. Using the multiple logistic regression model, people with frailty had an OR of 11.6 of dying from Covid-19 compared to robust people (p-value = 0.024). CONCLUSION: The Covid-19 outbreak was initially caused by a resident of the center and spread by cross infection. In vulnerable populations, early detection, isolation, and follow-up of contacts should be carried out, as well as the identification of risk factors in order to reduce the spread and mortality caused by SARSCoV-2.
Asunto(s)
COVID-19/epidemiología , Brotes de Enfermedades , Hogares para Ancianos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , MéxicoRESUMEN
INTRODUCTION: COVID-19-associated mortality in patients who require mechanical ventilation is unknown in the Mexican population. OBJECTIVE: To describe the characteristics of Mexican patients with COVID-19 who required mechanical ventilation. METHODS: Observational cohort study carried out in an intensive care unit from March 25 to July 17, 2020. Data were obtained from a prospective database and electronic medical records, and were analyzed with the chi-square test, Fisher's exact test or Mann-Whitney's U-test. RESULTS: One hundred patients required mechanical ventilation; median age was 56 years, 31 % were females and 97 % were Latin American. Most common comorbidities were obesity (36 %), diabetes (26 %), hypertension (20 %), and chronic or end-stage kidney disease (10 %). At the end of the analysis, 11 patients remained in the ICU, 31 had been discharged alive and 58 (65.2 %) died; survivors were younger, had lower scores on severity and organ dysfunction scales, lower levels of C-reactive protein at ICU admission, were less likely to receive hemodialysis and vasopressors, and had longer hospital and ICU stays. CONCLUSIONS: This study adds information on the presentation and results of SARS-CoV-2-infected patients who require mechanical ventilation.
INTRODUCCIÓN: La mortalidad por COVID-19 en quienes requieren ventilación mecánica se desconoce en la población mexicana. OBJETIVO: Describir las características de pacientes mexicanos con COVID-19 que requirieron ventilación mecánica. MÉTODOS: Estudio de cohorte observacional en una unidad de terapia intensiva, del 25 de marzo al 17 de julio de 2020. Los datos se obtuvieron de una base de datos prospectiva y de registros clínicos electrónicos; fueron analizados con c2, prueba exacta de Fisher o prueba U de Mann-Whitney. RESULTADOS: Cien pacientes recibieron ventilación mecánica, la edad media fue de 56 años, 31 % era del sexo femenino y 97 %, latinoamericano. Las comorbilidades más comunes fueron obesidad (36 %), diabetes (26 %), hipertensión (20 %) y enfermedad renal crónica o renal terminal (10 %). Al término del análisis, 11 pacientes permanecían en la UCI, 31 egresaron vivos y 58 (65.2 %) fallecieron; los sobrevivientes fueron más jóvenes, con menores puntuación en las escalas de gravedad y disfunción orgánica, menores niveles de proteína C reactiva al ingreso a la UCI, menor propensión a hemodiálisis, necesidad de, necesidad de vasopresores y con mayor estancia hospitalaria y en la UCI. CONCLUSIONES: Este estudio agrega información sobre la presentación y resultados de pacientes con ventilación mecánica infectados con SARS-CoV-2.
Asunto(s)
COVID-19/mortalidad , COVID-19/terapia , Respiración Artificial , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate the occurrence of adverse events during a multifaceted program implementation. DESIGN: Cross-sectional secondary analysis. SETTING: The respiratory-ICU of a large tertiary care center. PARTICIPANTS: Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used. INTERVENTIONS: The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented. MAIN OUTCOME MEASURES: Rates of adverse events (episodes per 1000 patient/days). RESULTS: Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97). CONCLUSIONS: A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU.
Asunto(s)
Cultura Organizacional , Paquetes de Atención al Paciente , Unidades de Cuidados Respiratorios/organización & administración , Planificación Estratégica , Extubación Traqueal/estadística & datos numéricos , Estudios Transversales , Higiene de las Manos , Mortalidad Hospitalaria , Humanos , Seguridad del Paciente/estadística & datos numéricos , Neumotórax/prevención & control , Atelectasia Pulmonar/prevención & control , Unidades de Cuidados Respiratorios/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
OBJECTIVE: Identify the association between working conditions, musculoskeletal symptoms and ergonomic demands on nurses. BACKGROUND: The physical demands of nursing often require repetitive and forced movements that increase the likelihood of developing musculoskeletal disorders, which are the main occupational diseases in this working population. METHODOLOGY: Cross-sectional study of 329 nurses chosen at random. Initial symptoms of musculoskeletal disorders (MSDs) were evaluated using Kuorinka's Nordic questionnaire; occupational demands and domestic activities were evaluated using the Individual Survey for Workers' Health, PROESSAT. Logistic regression models were fit to identify associations between musculoskeletal symptoms and occupational activities. RESULTS: A prevalence of 87% and 83% of musculoskeletal disorders was found in the neck and dorsal/lumbar regions, respectively. Using logistic models, associations were identified between ergonomic requirements, exposure time, domestic work, supervision and discomfort in various regions of the body. CONCLUSIONS: Postural demands are closely associated with the development of musculoskeletal disorders. Early identification and timely intervention are fundamental. IMPLICATIONS FOR NURSING MANAGEMENT: Musculoskeletal disorders are very common among nurses and are closely associated with occupational tasks.
Asunto(s)
Enfermedades Musculoesqueléticas/diagnóstico , Enfermeras y Enfermeros/estadística & datos numéricos , Adulto , Estudios Transversales , Empleo/métodos , Empleo/normas , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Encuestas y Cuestionarios , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
INTRODUCTION: New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area. OBJECTIVE: To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events. METHOD: Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days. RESULTS: Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12-0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24-5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes. CONCLUSIONS: In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU.
INTRODUCCIÓN: Nuevos hospitales están reemplazando a instalaciones antiguas. Existe poca información del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área nueva y equipada. OBJETIVO: Analizar el impacto del cambio de instalaciones de un ambiente compartido a camas individuales en la ocurrencia de eventos adversos en la UCI. MÉTODO: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 1 de marzo de 2014 al 28 de febrero de 2017 a la antigua UCI (aUCI) y del 17 de julio de 2017 al 17 de enero de 2019 a la nueva UCI (nUCI) de un hospital-escuela público. La tasa de eventos adversos se midió en eventos por 1000 días-paciente. RESULTADOS: En 1188 pacientes (aUCI, n = 681 versus nUCI, n = 507) se observó reducción en la tasa de paro cardiaco no previsto (razón de tasas 0.31, IC 95 % = 0.12-0.80) e incremento en la tasa de extubación no planeada (razón de tasas 2.49, IC 95 % = 1.24-5.01), estadísticamente significativos; los otros nueve eventos adversos monitoreados no mostraron cambios. CONCLUSIONES: Comparada con la aUCI, la mayor parte de eventos adversos monitoreados no se modificaron significativamente en los 18 meses de inicio de actividades de la nUCI.
Asunto(s)
Extubación Traqueal/estadística & datos numéricos , Paro Cardíaco/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: High alcohol intake on weekends (binge drinking) is more frequent in young adults, who could undergo early liver damage. Alcohol-induced liver damage is characterized by polymorphonuclear cell (PMN) infiltration, which can be represented in the peripheral blood by altered trafficking and activation profiles. OBJECTIVE: To evaluate the PMN trafficking and activation immunophenotypic profiles in people with a binge drinking pattern. METHODS: People with binge drinking (n = 18, 8 females) or at low risk (n = 16, 13 females) based on their AUDIT and HEPCA scores were studied. Hematic biometry and liver enzyme tests were conducted. Peripheral blood leukocytes were stained for CCR5, CCR4, and CXCR4 (trafficking) and CD69 and CD127 (activation). PMNs and monocytes were analyzed by FACS. The data were analyzed using the T-test and Mann-Whitney's U-test for contrasts and principal component and Fuzzy C means analyses for clustering, with p < 0.05 considered significant. RESULTS: Compared to the low-risk group, the binge group showed higher CCR5 expression on PMNs, decreases in the CD69 percentage and positive PMNs per microliter, and decreased CXCR4 expression on monocytes. Six immunophenotypical clusters were identified, all of which were distributed following the CCR5 and CXCR4 main vectors. CONCLUSION: Young adult binge drinkers have differential PMN trafficking and activation immunophenotypes, which could be related to the initial onset of alcoholic liver disease and a systemic inflammatory state in response to their alcohol consumption pattern. These findings could lead to the future development of an early diagnostic tool.
Asunto(s)
Consumo Excesivo de Bebidas Alcohólicas/sangre , Leucocitos Mononucleares/inmunología , Monocitos/inmunología , Adulto , Consumo Excesivo de Bebidas Alcohólicas/inmunología , Femenino , Humanos , Inmunofenotipificación , Masculino , Adulto JovenAsunto(s)
COVID-19 , COVID-19/epidemiología , Comorbilidad , Hospitales Generales , Humanos , México/epidemiología , Factores de RiesgoAsunto(s)
Tuberculosis Pulmonar/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales Especializados , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Salud Urbana , Adulto JovenRESUMEN
OBJECTIVES: To analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. METHODS: Observational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p<0.05 was considered significant. RESULTS: A sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p=0.001) as well as the multiple spaces involvement, (p=0.001) the presence of air corpuscles, (p=0.001) compromise of the retropharyngeal space (p=0.001) and age greater than 55 years (p=0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p=0.001, 95% CI 0.856-0.984). CONCLUSIONS: The clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. LEVEL OF EVIDENCE: IV.
Asunto(s)
Absceso Retrofaríngeo , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adolescente , Estudios Transversales , Estudios Retrospectivos , Cuello , Manejo de la Vía AéreaRESUMEN
Background: The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method. Methods: This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects. Results: A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group. Conclusion: The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.
RESUMEN
OBJECTIVE: To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. MATERIALS AND METHODS: The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. RESULTS: Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. CONCLUSION: UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.
Asunto(s)
Enfermedad Crónica/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Esenciales/provisión & distribución , Humanos , MéxicoRESUMEN
Extrapulmonary tuberculosis is defined as that case of tuberculosis clinically diagnosed and confirmed by bacteriological studies that affects tissues and organs outside the lung parenchyma. Mexico is in third place among Latin American countries in terms of the incidence of pulmonary and extrapulmonary tuberculosis. Culture methods are still the gold standard for the diagnosis of extrapulmonary tuberculosis since they identify the species and susceptibility to drugs.
La tuberculosis extrapulmonar es aquella tuberculosis diagnosticada clínicamente y confirmada por estudios bacteriológicos que afecta a tejidos y órganos fuera del parénquima pulmonar. México es el tercer lugar en América Latina en incidencia de tuberculosis pulmonar y extrapulmonar. Los métodos de cultivo siguen siendo el método de referencia para el diagnóstico de tuberculosis extrapulmonar, ya que identifican la especie y la sensibilidad a los fármacos.
Asunto(s)
Mycobacterium tuberculosis , Tuberculosis Extrapulmonar , Tuberculosis , Humanos , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Pulmón , México/epidemiologíaRESUMEN
OBJECTIVE: this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care. METHOD: a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used. RESULTS: 280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff. CONCLUSION: the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.
Asunto(s)
Agotamiento Profesional , COVID-19 , Enfermeras y Enfermeros , Médicos , Humanos , Femenino , Estudios Transversales , COVID-19/epidemiología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Patients with respiratory diseases face adverse situations such as symptom management, general condition deterioration, and a hostile perception of the hospital environment, favoring the appearance of anxiety and depression. METHODS: A total of 317 patients hospitalized for a disease of pulmonary origin were analyzed and divided into the following subgroups: infectious, oncological, acute, and chronic diseases. Patients over 18 years of age with preserved cognitive capacity were included in the study. The Hospital Anxiety and Depression Scale (HADS) was applied to them on the second or fourth day of their hospital stay and five days after the first evaluation. Multiple linear regression models were carried out to analyze the association between anxiety and depression measured over two different periods. The models present the statistically significant variables with a 95% confidence level. RESULTS: The patients presented with anxiety in 74.4% of cases, mainly those with acute respiratory diseases (42.4%) and neoplastic diseases (27.5%). A total of 69.5% presented with depression, with symptoms more significant in those with chronic and oncological pulmonary diseases and those with no job. Patients with at least one comorbidity presented with anxiety in 53.9% of cases and depression in 52.1% of cases. Linear regression models were carried out and showed that anxiety was 1.75 and 1.84 times more frequent in patients with chronic diseases compared to those with infectious pathologies in the first and second reviews, respectively. The linear regression model also showed a higher frequency of depressive symptoms in patients with chronic conditions (1.62 times) compared to the group with infectious and contagious pathologies, and prolonged hospital stays were associated with depressive symptoms 1.37 times more than short stays. CONCLUSIONS: Anxiety and depression are frequent disorders in patients with respiratory diseases, negatively affecting the prognosis. Routine mental health screening and multidisciplinary management are essential in this population.
RESUMEN
OBJECTIVE: To evaluate efficacy and safety between dual angiotherapy (endocoil plus N-butyl-cyanoacrylate) guided by endoscopic ultrasound) versus N-butyl-cyanoacrylate in the secondary prophylaxis of gastroesophageal varices (GOV). METHOD: Prospective non-inferiority study comparing two gastric variceal eradication techniques. We evaluated technical and clinical success, GOV occlusion and eradication, rebleeding, reoperation, GOV-free period, complications, and mortality. Chi square for categorical variables and Student's t for numerical variables with a significance level of 0.05. RESULTS: There were 68 patients (average age 55.5 ± 10 years, women 44 (64.7%) and average body mass index 25.7 ± 3.5 kg/m2). The most frequent cause was alcoholic steatohepatitis (58%). Dual therapy had greater technical (100% vs. 94.3%) and clinical (100% vs. 85%) success. Obliteration was faster (100 vs. 79.2%). This group only required one session. The GOV size was 24 ± 14 mm and 1-2 endocoils were placed. The median follow-up was 221 days. The reoperation-free rate was high (100% vs. 94%; p = 0.9). CONCLUSIONS: Dual angiotherapy guided by endoscopic ultrasound and cyanoacrylate injection are effective for the eradication of GOV without differences in adverse event rates.
OBJETIVO: Evaluar la eficacia y la seguridad de la angioterapia dual (endo-coil más N-butil-cianoacrilato) guiada por ultrasonido endoscópico) frente a N-butil-cianoacrilato solo en la profilaxis secundaria de várices gásctricas. MÉTODO: Estudio prospectivo de no inferioridad comparando dos técnicas de erradicación de várices gástricas. Se evalúan el éxito técnico y clínico, la oclusión y la erradicación de GOV, el resangrado, la reintervención, el período libre de GOV, las complicaciones y la mortalidad. Análisis estadístico mediante prueba de χ2 para variables categóricas y t de Student para las numéricas, con nivel de significancia de 0.05. RESULTADOS: Fueron 68 pacientes (edad promedio 55.5 ± 10 años, mujeres 44 (64.7%) e índice de masa corporal promedio 25.7 ± 3.5 kg/m2). La causa más frecuente fue esteatohepatitis alcohólica (58%). La terapia dual tuvo mayor éxito técnico (100% vs. 94.3%) y clínico (100% vs. 85%), y la obliteración fue más rápida (100 vs. 79.2%); este grupo solo requirió una sesión. El tamaño de las GOV fue de 24 ± 14 mm y se colocaron uno o dos endo-coils. La mediana de seguimiento fue de 221 días. La tasa de libres de reintervención fue alta (100% vs. 94%; p = 0.9). CONCLUSIONES: La angioterapia dual guiada por ultrasonido y la inyección de cianoacrilato son efectivas para la erradicación de las GOV, sin diferencias en las tasas de eventos adversos.
Asunto(s)
Enbucrilato , Várices Esofágicas y Gástricas , Anciano , Enbucrilato/efectos adversos , Enbucrilato/uso terapéutico , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/terapia , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Deep neck abscesses can cause life-threatening complications. They are diagnosed by physical examination, and contrasted tomography as the gold standard. There are no studies about the association of Moore's sign with infections of the retropharyngeal space. OBJECTIVE: To determine the usefulness of Moore's sign in the diagnosis of deep retropharyngeal abscess. METHOD: Observational, analytical, cross-sectional, study of patients with deep neck abscess, from May 1, 2019, to August 30, 2021, with report of Moore's sign. RESULTS: 87 patients were included, 49 (56.3%) males (p = 0.45). Of those who developed complications, 77.8% had a negative Moore's sign (p = 0.001). Of those admitted to the ICU, 72% had a negative Moore's sign (p = 0.001). The sensitivity of the absence of the sign with retropharyngeal involvement was 95.4%, and the specificity was 86.3%. By logistic regression, it was found that those with retropharyngeal involvement are 467 times more likely to present a negative sign (p < 0.05). CONCLUSIONS: The presence of abscess in the retropharynx is associated with complications and a worse prognosis. The evaluation of Moore's sign can be a useful tool to suspect compromise of this space.
ANTECEDENTES: Los abscesos profundos de cuello pueden ocasionar complicaciones letales. Se diagnostican por exploración física, y la tomografía contrastada es el método de referencia. No existen estudios de asociación del signo de Moore con infecciones del espacio retrofaríngeo. OBJETIVO: Determinar la utilidad del signo de Moore en el diagnóstico de absceso profundo en el espacio retrofaríngeo. MÉTODO: Estudio observacional, transversal y analítico, de pacientes con absceso profundo de cuello, del 1 de mayo de 2019 al 30 de agosto de 2021, con reporte de signo de Moore. RESULTADOS: Se incluyeron 87 pacientes, de los cuales 49 (56.3%) eran de sexo masculino (p = 0.45). De los que desarrollaron complicaciones, el 77.8%, tenían el signo de Moore negativo (p = 0.001). De los que ingresaron a la unidad de cuidados intensivos, el 72% tenían negativo el signo de Moore (p = 0.001). La sensibilidad de la ausencia del signo con afección del espacio retrofaríngeo fue del 95.4%, y la especificidad del 86.3%. Por regresión logística se encontró que aquellos con afección del espacio retrofaríngeo tienen 467 veces más posibilidades de presentar signo negativo (p < 0.05). CONCLUSIONES: La presencia de un absceso en el espacio retrofaríngeo se asocia a complicaciones y peor pronóstico. La evaluación del signo de Moore puede ser una herramienta útil para sospechar compromiso de ese espacio.
Asunto(s)
Absceso , Cuello , Femenino , Humanos , Masculino , Absceso/diagnóstico por imagen , Estudios Transversales , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To assess the efficacy and safety of infliximab versus placebo in the treatment of patients with juvenile-onset spondyloarthritis (JoSpA). METHODS: Phase III, randomized, double-blind, placebo-controlled trial of 12 weeks that included patients ≤ 18 years old with JoSpA not responding to nonsteroidal anti-inflammatory drugs, sulfasalazine, or methotrexate. Patients were randomly assigned 1:1 to the infusion of infliximab 5mg/kg or placebo; completers entered then an open-label extension (OLE) period of 42 weeks. The primary endpoint was the number of active joints. Secondary outcomes included the assessment of disease activity, tender entheses, spinal mobility, serum C-reactive protein (CRP), the Bath Ankylosing Spondylitis Disease Activity and Functional Index, and the Childhood Health Assessment Questionnaire (CHAQ). RESULTS: We randomized 12 patients to infliximab and 14 to placebo. No significant differences were found between groups at baseline. At week 12, the mean number of active joints was 1.4 (SD 2.4) in the infliximab group and 4.1 (SD 3.0) in the placebo group (p = 0.0002). A repeated-measures mixed model analysis that included all endpoints in the study demonstrated sustained favourable outcomes of infliximab for active joints, tender joints, swollen joints, and tender enthesis counts, as well as for CHAQ and CRP (p < 0.01). Adverse events were more frequent in the infliximab group, including infections and infusion reactions, but none of them was serious. CONCLUSION: Infliximab is efficacious for patients with JoSpA with an inadequate response to conventional treatment. No serious adverse events with the use of infliximab were observed.
Asunto(s)
Antirreumáticos , Artritis Juvenil , Espondiloartritis , Espondilitis Anquilosante , Adolescente , Artritis Juvenil/tratamiento farmacológico , Proteína C-Reactiva , Niño , Método Doble Ciego , Humanos , Infliximab/uso terapéutico , Espondiloartritis/tratamiento farmacológico , Espondilitis Anquilosante/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Background and study aims The light blue crest observed in narrow band imaging endoscopy has high diagnostic accuracy for diagnosis of gastric intestinal metaplasia (GIM). The objective of this prospective study was to evaluate the diagnostic accuracy of magnifying i-scan optical enhancement (OE) imaging for diagnosing the LBC sign in patients with different levels of risk for gastric cancer in a Mexican clinical practice. Patients and methods Patients with a history of peptic ulcer and symptoms of dyspepsia or gastroesophageal reflux disease were enrolled. Diagnosis of GIM was made at the predetermined anatomical location and white light endoscopy and i-scan OE Mode 1 were captured at the two predetermined biopsy sites (antrum and pyloric regions). Results A total of 328 patients were enrolled in this study. Overall GIM prevalence was 33.8â%. The GIM distribution was 95.4â% in the antrum and 40.5â% in the corpus. According to the Operative Link on Gastritis/Intestinal-Metaplasia Assessment staging system, only two patients (1.9â%) were classified with high-risk stage disease. Sensitivity, specificity, positiveâ and negative predictive values, positive and negative likelihood ratios, and accuracy of both methods (95â% C.âI.) were 0.50 (0.41-0.60), 0.55 (0.48-0.62), 0.36 (0.31-0.42), 0.68 (0.63-0.73), 1.12 (0.9-1.4), 0.9 (0.7-1.1), and 0.53 (0.43-0.60) for WLE, and 0.96 (0.90-0.99), 0.91 (0.86-0.94), 0.84 (0.78-0.89), 0.98 (0.94-0.99), 10.4 (6.8-16), 0.05 (0.02-0.12), and 0.93 (0.89-0.95), respectively. The kappa concordance was 0.67 and the reliability coefficient was 0.7407 for interobserver variability. Conclusions Our study demonstrated the high performance of magnifying i-scan OE imaging for endoscopic diagnosis of GIM in Mexican patients.
RESUMEN
BACKGROUND: Diabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications. AIMS: To describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity. METHODS: Case-control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient. RESULTS: From the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001). CONCLUSIONS: Our results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality.