Co-Management Reduces Mortality in Post-Sternotomy Mediastinitis.

Background: Post-sternotomy mediastinitis (PSM) is one of the most feared complications of cardiac surgery. The impact of a multidisciplinary management approach on this pathology is yet unknown. Patients and Methods: A multidisciplinary approach based on a co-management model (CMM) of care was initiated in January 2018 because of the incorporation of a hospitalist unit on a cardiac surgery department. An observational retrospective cohort study was designed to evaluate the impact of the CMM of care compared to the standard model (SM) of care in patients diagnosed with PSM. Our primary and secondary outcomes were survival time and treatment failure rate (two or more surgical procedures needed to solve PSM or PSM-related death), respectively. Data related to patient death date were collected from the Spanish National Death Index. A multivariable Cox regression model was created using those variables believed to be clinically relevant. Results: Ninety-one patients developed PSM from January 2010 to June 2020. Regarding the pre-operative clinical status, surgical procedure, and PSM severity, both groups had similar baseline characteristics. Patients were followed for a mean of 27.54 ± 30.5 months. A total of 60.3% of the SM group and 11.1% of the CMM group (p < 0.001) died. Treatment failure occurred in 53 patients (72.6%) in the SM group versus 7 (38.6%) in the CMM group (p = 0.007). The CMM independently reduced overall mortality (hazard ratio [HR], 0.11; 95% confidence interval [CI]. 0.01-0.83) and treatment failure rate (HR, 0.01; 95% CI, 0.001-0.183). Gram-positive bacterial infection (HR, 3.73; 95% CI, .6-8.3), and complete osteosynthesis material removal (HR, 0.47; 95% CI, 0.24-0.91) also influenced mortality in our model. Conclusions: A co-management care model reduced overall mortality in patients diagnosed with post-sternotomy mediastinitis.

Artralgia inducida por levofloxacina: Reporte de un caso / Levofloxacin induced arthralgia: a case report

Mujer quien inició tratamiento de rescate de segunda línea para Helicobacter pylori con levofloxacina un gramo cada 12 horas, amoxicilina 500 mg cada 8 horas y lansoprazol 40 mg cada 24 horas. Al quinto día de tratamiento manifestó mialgias generalizadas seguido por artralgias y limitación del movimiento en rodillas y codos. Al séptimo día, sin mejora, la paciente suspende la medicación y presenta resolución completa de los síntomas una semana después. No hubo secuelas, ni complicaciones, ni re-exposición al medicamento. El caso fue clasificado como probable, con un puntaje de siete en la escala de Naranjo. Este caso nos recuerda que la administración de fluoroquinolonas puede asociarse con artralgias y artropatía reversible aguda, y debería ser la primera sospecha diagnóstica en pacientes sin comorbilidad.

Woman who initiated second-line rescue therapy for Helicobacter pylori with levofloxacin one gram every 12 hours, amoxicillin 500 mg every 8 hours and lansoprazole 40 mg every 24 hours. On the fifth day of treatment, she manifested generalized myalgia followed by bilateral knee and elbow arthralgia with limitation of movements. On the seventh day, without improvement, the patient discontinues the medication and achieve complete resolution of the symptoms one week later. There were no sequelae, no complications, no re-exposure to the drug. The case was classified as probable attaining a score of seven under the Naranjo's scale. This case reminds us that administration of fluoroquinolones may be associated with arthralgia and acute reversible arthropathy and should be the first diagnostic suspicion in patients without comorbidity.

Perfil clínico y epidemiológico de pacientes con enfermedad pulmonar obstructiva crónica hospitalizados en un centro de alta complejidad de la ciudad de medellín, colombia, durante el año 2015

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es una condición que cursa con limitación del flujo aéreo espiratorio e inflamación crónica de las vías aéreas, y que representa un problema de salud pública a nivel mundial. Objetivo. Determinar el perfil clínico y epidemiológico de pacientes con EPOC en una institución hospitalaria de la ciudad de Medellín, Colombia. Metodología. Se realizó un estudio transversal, con una muestra de 50 pacientes, con diagnóstico clínico o espirométrico de enfermedad pulmonar obstructiva crónica, atendidos de forma intrahospitalaria en una institución privada en Medellín durante el año 2015. A las variables cuantitativas se les calculó el promedio, desviación estándar y valores mínimo y máximo. A las cualitativas, medidas de nivel nominal y ordinal y se les estimaron proporciones. Resultados. La edad promedio fue de 73,5±9,3 años, el 52% fueron mujeres. El promedio de tiempo de diagnóstico fue de 7,8±1,3 años. Las características clínicas más frecuentes fueron las siguientes: el 36% tenía como clasificación estadio D para la enfermedad, el 34% tenía VEF1 <30%, el 88% tenían antecedente de tabaquismo y el 52% utilizaba oxígeno en casa. Conclusiones. La mayoría de nuestra población fue clasificada como GOLD categoría D, con una limitación grave del flujo aéreo espiratorio (VEF1 < 30%) y requerimiento de uso de oxígeno domiciliario. Lo anterior indica un inadecuado control de la enfermedad, debido, probablemente, al contexto intrahospitalario de los pacientes incluidos en el estudio.

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a condition that limits the air flow and produce chronic inflammation of the airways, which represents a public health problem worldwide. Objective. To determine the clinical and epidemiological profile of patients with COPD in a hospital of the city of Medellin, Colombia. Methodology. A cross-sectional study was carried out, with a sample of 50 subjects, who had a clinical or spirometric diagnosis of Chronic Obstructive Pulmonary Disease, receiving Inpatient care in a private institution in Medellin in 2015. It was calculated on quantitative variables, the average, standard deviation and minimum and maximum values. It was estimated on qualitative variables, measures of nominal and ordinal level and proportions. Results. The average age was 73.5 ) 9,3 years, 52% were women. The average of Diagnostic time was 7.8 ) 1,3 years. The most common clinical characteristics were the following: 36% had a stage D classification for the disease, 34% had FEV1 <30%, 88% had a smoking history and 52% used oxygen at home. Conclusions. The majority of our population was classified as GOLD category D, with a severe limitation to breath (FEV1 <30%) and had to use oxygen at home. The foregoing indicates that there is an inadequate control of the disease, due to the inpatient environment of the subjects involved in the study.

Introdução. A doença pulmonar obstrutiva crônica (DPOC) é uma condição caracterizada por fluxo respiratório limitado e inflamação crônica das vias aéreas, e representa um problema de saúde pública em todo o mundo. Objetivo. Determinar o perfil clínico e epidemiológico dos pacientes com DPOC em uma instituição hospitalar da cidade de Medellín, Colômbia. Metodologia. Foi realizado um estudo transversal, com uma amostra de 50 pacientes, com diagnóstico clínico e espirométrico da doença pulmonar obstrutiva crônica, que receberam atenção hospitalar em uma instituição privada em Medellín durante o ano de 2015. Para as variáveis quantitativos foram calculados a média, desvio padrão e valores mínimo e máximo. Para medidas qualitativas de nível nominal e ordinal se estimaram proporções. Resultados. A idade média foi de 73,5 ± 9,3 anos, 52% eram mulheres. A média do tempo de diagnóstico foi de 7,8 ± 1,3 anos. As características clínicas mais frequentes foram: 36% tinham classificação no estádio D para a doença, 34% tinham VEF1 <30%, 88% tinham história de tabagismo e 52% usavam oxigênio em casa. Conclusões. A maioria da nossa população foi classificada como GOLD categoria D, com uma limitação severa do fluxo de ar (VEF1 <30%) e exigência de uso de oxigênio domiciliar. O que precede indica um controle inadequado da doença, devido, provavelmente, ao contexto hospitalar dos pacientes incluídos no estudo.

Myoclonus induced by salbutamol: A case report

Salbutamol is a ß2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the ß2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

Mioclonías inducidas por salbutamol / Myoclonus induced by salbutamol: A case report

Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.

Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

Malaria, enfermedad tropical de múltiples métodos diagnósticos / Malaria, tropical disease of multiple diagnostic methods

La malaria es una enfermedad causada por el parasito de género Plasmodium, que se transmite mediante la picadura de la hembra del mosquito Anopheles. Entre los años 2000 a 2015 se han reportado 212 millones de casos a nivel mundial. En Colombia, la malaria es considerada un problema de salud pública, se estima que al menos el 70% del territorio cuenta con las condiciones ecológicas necesarias para la transmisión del parasito. Para evitar el aumento en el número de casos de malaria, se utilizan 3 pilares de prevención: evitar la exposición y realizar control del vector, quimioprofilaxis y diagnóstico oportuno. Después de este último, se debe brindar el tratamiento, cuyos objetivos son: curación clínica del paciente, curación radical de la infección y control de la transmisión. Para el diagnóstico, existen diferentes métodos, los cuales se evalúan y diferencian de acuerdo a la sensibilidad y especificidad; con base en esto, se define el Gold Standard, como prueba de referencia. En la actualidad, el Gold Standard para el diagnóstico de malaria es un método microscópico: gota gruesa. Sin embargo, existen otros métodos: extendido de sangre periférica, métodos moleculares y métodos serológicos..(AU)

Malaria is a disease caused by the parasite of the genus Plasmodium, which is transmitted by the bite of the female Anopheles mosquito. Between 2000 and 2015, 212 million cases have been reported worldwide. In Colombia, malaria is considered a public health problem, it is estimated that at least 70% of the territory has the necessary ecological conditions for the transmission of the parasite. To avoid the increase of the number of malaria cases, three pillars of prevention are used: avoiding exposure and performing vector control, chemoprophylaxis and timely diagnosis. After this, the treatment should be provided. The objectives of the treatment are: clinical cure of the patient, radical cure of infection and control of transmission. To diagnosis, there are different methods, which are evaluated and differentiated according to sensitivity and specificity; Based on this, the Gold Standard is defined as the Benchmark test. Nowadays, the Gold Standard for the diagnosis of malaria is a microscopic method call thick gout. However, there are other methods such as: peripheral blood smear, molecular methods and serological methods..(AU)

Identificación de la delimitación administrativa de la malaria usando redes neuronales artificiales / Boundary Delimitiation of Malaria using Artificial Neural Networks / Identificação da Delimitação Administrativa da Malária usando Redes Neurais Artificiais

Resumen La metodología de clustering fue utilizada para agrupar tres barrios en Quibdó teniendo en cuenta factores que favorecen el desarrollo de la malaria. Los mapas auto-organizados de Kohonen fueron utilizados para el análisis de las características más significativas en la clasificación. Los clusters detectados fueron comparados con la clasificación geográfica de las casas, encontrando, que los mapas auto-organizados de Kohonen clasifican las casas por las condiciones ambientales propicias para el desarrollo del mosquito más que por la clasificación administrativa de la ciudad.

Resumo A Metodologia de Clustering foi usada para agrupar três bairros em Quibdo, Colômbia, levando em consideração fatores que favorecem o desenvolvimento da malária. Mapas auto-organizados de Kohonen foram utilizados para a análise das características mais significativas no agrupamento. Os Clusters detectados foram comparados com o agrupamento geo-gráfico de casas, mostrando que os mapas auto-organizados de Kohonen agrupam as casas pelas condições ambientais favoráveis ao desenvolvimento do mosquito e não pelo agrupamento administrativo da cidade.

Abstract Clustering methodology was used to group three neighborhoods in Quibdo taking into account factors that favor the development of malaria. The Kohonen self-organizing maps were used for the analysis of the most significant features in the standings. The detected clusters were compared with the geographical classification of houses, finding that the Kohonen self-organizing maps households classified by environmental conditions conducive to development rather than the administrative classification of the city.