Utilidad del score NIHSS como predictor de complicaciones intrahospitalarias no neurológicas en ictus isquémico / Usefulness of NIHSS score as a predictor of non-neurological in-hospital complications in stroke

Introducción: Los pacientes con ictus isquémico (II) presentan riesgo de desarrollar complicaciones intrahospitalarias no neurológicas (CIHNN) durante la internación. El NIHSS es una escala utilizada y validada para determinar la gravedad, el tratamiento y el pronóstico del II. Evaluamos la relación entre el puntaje NIHSS obtenido al ingreso y el desarrollo de CIHNN durante la estancia hospitalaria.MétodosEstudio observacional, de cohortes prospectivas. Incluyó pacientes ingresados consecutivamente por II en una sala de cuidados intermedios entre el 1 de agosto de 2017 y el 29 de febrero de 2020 en Argentina. Se dividió a los pacientes en Grupo1 (con CIHNN) y Grupo2 (sin CIHNN).ResultadosLa n final constó de 78 individuos; 41% mujeres. Al comparar las medias de puntaje NIHSS se observaron diferencias entre los grupos para desarrollo de CIHNN en general (p=0,050) y para las siguientes complicaciones específicas: disfagia (p=0,014), neumonía aspirativa (p=0,006), neumonía intrahospitalaria (p=0,010) e infección urinaria intrahospitalaria (p=0,004). El punto de corte de 10,5 presentó el mejor desempeño predictivo de CIHNN (AUC=0,706; p=0,016).ConclusionesUn valor de NIHSS ≥10,5 se relacionó con el desarrollo de CIHNN en pacientes ingresados por II. (AU)

Introduction: Patients with stroke are at risk of developing non-neurological in-hospital complications (NNIHC) during hospitalization. The NIHSS is a scale used and validated to determine stroke severity, treatment, and prognosis. We evaluated the relationship between the NIHSS score obtained on admission and the development of NNIHC during hospital stay.MethodsObservational study of prospective cohorts. Patients admitted consecutively for stroke, to an intermediate care ward, in Argentina between 08/01/2017 and 02/29/20 were included. The patients were divided into Group1 (with NNIHC) and Group2 (without NNIHC).ResultsThe final n consisted of 78 individuals, 41% women. When comparing the means of the NIHSS score, differences were observed between the groups in the development of NNIHC in general (P=.050) and in the following specific complications: dysphagia (P=.014), aspiration pneumonia (P=.006), in-hospital pneumonia (P=.010) and intrahospital urinary infection (P=.004). The cut-off point of 10.5 presented the best predictive performance of NNIHC (AUC=.706; P=.016).ConclusionsAn NIHSS value ≥10.5 was related to the development of NNIHC in patients admitted for stroke. (AU)

Usefulness of NIHSS score as a predictor of non-neurological in-hospital complications in stroke. / Utilidad del score NIHSS como predictor de complicaciones intrahospitalarias no neurológicas en ictus isquémico.

INTRODUCTION: Patients with stroke are at risk of developing non-neurological in-hospital complications (NNIHC) during hospitalization. The NIHSS is a scale used and validated to determine stroke severity, treatment, and prognosis. We evaluated the relationship between the NIHSS score obtained on admission and the development of NNIHC during hospital stay. METHODS: Observational study of prospective cohorts. Patients admitted consecutively for stroke, to an intermediate care ward, in Argentina between 08/01/2017 and 02/29/20 were included. The patients were divided into Group1 (with NNIHC) and Group2 (without NNIHC). RESULTS: The final n consisted of 78 individuals, 41% women. When comparing the means of the NIHSS score, differences were observed between the groups in the development of NNIHC in general (P=.050) and in the following specific complications: dysphagia (P=.014), aspiration pneumonia (P=.006), in-hospital pneumonia (P=.010) and intrahospital urinary infection (P=.004). The cut-off point of 10.5 presented the best predictive performance of NNIHC (AUC=.706; P=.016). CONCLUSIONS: An NIHSS value ≥10.5 was related to the development of NNIHC in patients admitted for stroke.

La nueva epidemia: agresión hacia médicos en el ámbito laboral / The new epidemic: aggression against physicians in work places

Objetivos: Describir la prevalencia de eventos de agresión laboral contra médicos en la ciudad de Rosario y alrededores ocurridos en el último año. Determinar las características de los hechos de violencia y analizar la relación entrelos mismos y las características de la población médica.Materiales y Métodos: Estudio observacional, descriptivo y analítico, prospectivo; elaborado a partir de encuestascerradas on-line, realizadas de manera consecutiva a médicos que ejercieran en Rosario, Villa Gobernador Gálvez yGranadero Baigorria; del 18/07/2017 al 24/07/2017. Muestreo de tipo consecutivo, probabilístico, aleatorio simple. Se calculó un tamaño muestra de 350 encuestas.Resultados: Se incluyeron 351 encuestas. Hombres en 33% (n=115) y mujeres en 67% (n=236). El 23,1% (n=81)pertenecía al medio privado; 35% (n=123) al público; 41,6% (n=146) ambos y 0,3% (n=1) NS/NC. El 80,1%(n=281) presentó un episodio de agresión en el último año, de los cuales 86,8% (n=244) fue verbal y 13,2%(n=37) física-verbal. La agresión, pudiendo identificarse más de un agresor, fue realizada por familiar del pacienteen 94%(n=237), paciente 66% (n=166), personal de salud no médico 33% (n=83) y 26% (n=67) por un colega.El sitio de agresión más frecuente fue la guardia externa. Las mujeres padecieron mayor cantidad de eventos deagresión. Las especialidades más agredidas fueron Obstetricia y Pediatría. Se identificaron como factores de riesgo:sexo femenino (p=0,01; OR=2; IC95%=1,1-3,4), ejercicio profesional en guardia externa (p<0,0001; OR=3,2;IC95%=1,8-5,8) y la especialidad pediatría (p=0,016; OR=1,2; IC95%=1,2-1,3)... (AU)

Purposes: Estimation of the prevalence of aggression events against physicians in the workplace in the city of Rosario and environmentsin last year. Description of the violence events and how they are related with the medical population characteristics.Materials and methods: This is an observational, descriptive and analytic, prospective research. Performed withphysicians working in Rosario, Villa Gobernador Gálvez and Granadero Baigorria cities, Santa Fe, Argentina in base ofclosed on line surveys in a consecutive way. The evaluation included the period from July 18th to July 24th, 2017. Thesample was consecutive, probabilistic and simply randomized. The calculated sample size was 350 surveys.Results: 351 surveys were included, 33% males (n=115) and 67% females (n=236). 23% (n=81) from privateinstitutions, 35% (n=236) public ones, 41,6% both (n=146) both and unknown / unanswered 0,3% (n=1). 80%(n=281) presented an episode of aggression in the previous year, of which 86% (n=244) was verbal and 13,2% (n=37)physical and verbal. The aggression was performed by a patient`s relative in 94% (n=237), the patient in 66% (n=166),non-medical health personnel 33% (n=83) and 26% (n=67) by a colleague. The most frequent place of aggression wasemergency room. The women suffered a higher frequency of aggression. Obstetrics and pediatrics were the specialties moreinvolved. The risk factors were: female sex (p=0.01; OR=2; CI95%=1,1-3,4); working in emergency room (p<0,0001;OR=3,2; IC95%=1,8-5,8 and the specialty of pediatrics (p=0,016; OR=1,2; CI95%=1,2-1,3)... (AU)

Serum 25-hydroxyvitamin D levels in hospitalized adults with community-acquired pneumonia.

INTRODUCTION: Community-acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. OBJECTIVE: The aim of this study was to evaluate the serum 25-hydroxyvitamin D (25OHD) levels in hospitalized adults in general room with CAP. MATERIALS AND METHODS: An observational study was carried out in 207 hospitalized adults of both sex with CAP (>18 years) from Rosario city, Argentina (32° 52' 18″S) between July 2015 and June 2016. RESULTS: In total, 167 patients were included in the data analysis [59% women (57.4 ± 19.6 years), body mass index 27.2 ± 7.8 kg/m2 ]. In brief, 63% showed unilobar infiltrate and 37% were multilobar. The CURB-65 index was 66.5% low risk, 16.0% intermediate risk and 17.5% high risk. According to Charlson comorbidity index (CCI) 53.5% had not comorbidity (CCI = 0) and 46.5% showed CCI ≥ 1. The 25OHD level was: 11.92 ± 7.6 ng/mL (51.5%: <10 ng/mL, 33.5%: 10-20 ng/mL, 13.2%: 20-30 ng/mL and 1.8%: >30 ng/mL). Higher 25OHD were found in male (female: 10.8 ± 6.7 ng/mL, male: 13.5 ± 8.5 ng/mL, P = .02) and 25OHD correlated with age (r = -.17; P = .02). 25-Hydroxyvitamin D was also correlated with CURB65 index (r = -.13; P = .049), CCI (r = -.20, P = .007) and with the 10 years of life expectative (%) (r = .19; P = .008). In addition, higher 25OHD were found with lower CCI (CCI 0 = 13.0 ± 8.2 ng/mL, CCI ≥ 1= 10.5 ± 6.7 ng/mL; P = .0093). CONCLUSIONS: Hospitalized adults with CAP have lower 25OHD levels and would be associated with the severity of CAP.

Utilidad de los criterios de predicción clínica y del test rápido antigénico para el manejo de la faringitis aguda en un servicio de urgencias / Usefulness of clinical prediction criteria and rapid antigen detection testing for the management of acute pharyngitis in an emergency department

Objetivo: Validar los criterios de CENTOR modificados (CENTOR-m) y los tests rápidos de detección del antígeno de Estreptococo del Grupo A (SGA) en la faringitis aguda. Diseño: Estudio de validación de pruebas diagnósticas. Emplazamiento y participantes: Ciento un pacientes elegibles, que consultaron al departamento de urgencias de un hospital de tercer nivel con cuadro clínico compatible con faringitis aguda. Mediciones Principales: Se obtuvieron muestras de hisopados faríngeos para la realización del test rápido antigénico para SGA (FAMR) y para cultivo, respectivamente. Se calculó en cada caso los criterios de CENTOR-m. Resultados: La edad media de los pacientes incluidos en el estudio fue de 22,6 años (DE:13,8). El 48,5 % eran varones. El SGA fue el patógeno aislado en el 20,79 % de los casos. El CENTOR-m presentó una sensibilidad del 83,3 % (50,9 %-97,1 %), especificidad del 45,5 % (30,7 %-61,0 %) valor predictivo positivo (VPP) del 29,4 % (15,7 %-47,7 %) y valor predictivo negativo (VPN) del 90,9 % (69,4 %-98,4 %). El FAMR presento una sensibilidad del 81,5 % (61,3 %-93,0 %) especificidad del 98,6 % (91,4 %-99,9 %), VPP del 95,7 % (76,0 %-99,8 %) y VPN del 93,3 % (84,5 %-97,5 %). El 49,5 % de los pacientes recibieron antibióticos basándose en el juicio médico, lo que resultó en una proporción de sobreindicación de antimicrobianos del 62 %. Conclusiones: Los criterios de CENTOR-m demostraron adecuado valor pronóstico negativo y el FAMR buena sensibilidad, especificidad y valor pronóstico positivo para faringitis por SGA. La utilización de ambos métodos en la atención urgente podría optimizar el manejo de la patología y la adecuación antibiótica (AU)

Objective: To validate the modified CENTOR score (m-CENTOR) and the rapid antigen detection testing for group A streptococcus (GAS) in acute pharyngitis. Design: Diagnostic test validation study. Location and Participants: 101 eligible patients, who consulted at the emergency department in a third level Hospital with a clinical picture compatible with acute pharyngitis. Main measures: Pharyngeal swabs were obtained for culture and rapid antigen detection testing for group A Streptococcus (FAMR). CENTOR score was calculated for each case. Results: The average age of the patients included in the study was 22.6 years (SD: 13.8). The gender distribution was 48.5% males. The group A Streptococcus (GAS) was the pathogen isolated in the 20.79% of the cases. The m-CENTOR presented a sensibility of 83.3 %(50.9%-97.1%), specificity 45.5% (30.7%-61.0%), positive predictive value (PPV) of 29.4% (15.7%-47.7%) and negative predictive value (NPV) 90.9% (69.4%-98.4%). The FAMR presented a sensibility of 81.5% (61.3%-93.0%), specificity 98.6% (91.4%-99.9%) PPV 95.7% (76.0%-99.8%) and NPV 93.3% (84.5%-97.5%). 49.5% of the patients received antibiotics based on medical judgment, which resulted in a 62% increase in antimicrobial indication. Conclusions: The m-CENTOR score evidenced an accurate negative predictive value, and the FAMR presented good sensibility, specificity and positive predictive value for pharyngitis caused by GAS. The use of both methods in emergency care could optimize the management of the pathology and improve antibiotic adequacy (AU)

Nuevos criterios diagnósticos de fibromialgia: ¿vinieron para quedarse? / New diagnostic criteria for fibromyalgia: here to stay?

Objetivos. Evaluar el grado de concordancia entre los criterios antiguos de fibromialgia (FM) y los criterios del American College of Rheumatology (ACR) 2010, valorar si hay correlación entre puntos y áreas dolorosas, así como los signos y los síntomas que permitan predecir un tipo específico de FM (depresivo, hiperalgésico o somatizador) e identificar aquellos que presenten mayor correlación con la afectación vital de la enfermedad. Materiales y métodos. Se realizó un estudio transversal comparativo en el que se incluyó a 206 pacientes con diagnóstico clínico previo de FM. Las variables evaluadas fueron: edad, sexo, años de evolución de la enfermedad, puntos dolorosos, puntos control, áreas dolorosas, presencia de fatiga, alteraciones del sueño y trastornos cognitivos, síntomas somáticos, tipo de FM, presencia de otras enfermedades reumatológicas y la puntuación promedio del cuestionario de impacto de la fibromialgia (FIQ). Resultados. Los nuevos criterios diagnósticos clasificaron correctamente el 87,03% de los casos que cumplían con la antigua definición. Ningún criterio fue superior al otro para valorar el impacto de la enfermedad. El 74,87% de los pacientes presentó una afectación vital severa. Se evidenció un predominio del tipo de FM somatizador. El tipo hiperalgésico presentó un promedio de FIQ más bajo que los tipos depresivo y somatizador. Conclusión. Los criterios del ACR 2010 constituyen una manera simple de evaluar pacientes con FM y tienen en cuenta las manifestaciones subjetivas de la enfermedad. Los nuevos criterios deberían convivir con los criterios antiguos; aportan una mayor comprensión y facilitan el manejo de esta patología tan prevalente (AU)

Objectives. To assess the percentage of patients that fulfill the American College of Rheumatology (ACR) 1990 as well as the ACR 2010 classification criteria, to evaluate whether there is a correlation between tender points and the Widespread Pain Index (WPI) as well as signs and symptoms that predict a fibromyalgia (FM) subtype and to identify those which have greater impact on functioning. Materials and methods. We performed a cross-sectional comparative study of 206 patients with previous clinical diagnosis of FM. The studied variables were age, sex, years of disease, tender points, control points, WPI, Symptom Severity Score, subtype of FM, presence of other rheumatic disorders and the Fibromyalgia Impact Questionnaire (FIQ) score. Results. The new diagnostic criteria of FM correctly classified 87,03% of patients who satisfied the ACR 1990 criteria. Both criteria were equally effective in assessing the impact of the disease. FM had a severe impact on the quality of life in 74,87% of patients. Somatoform disorder was the predominant subtype. Hyperalgesic FM had a significantly lower FIQ score than the somatoform disorder and depressive subtypes. Conclusion. The ACR 2010 criteria are a simple evaluation tool to use in the primary care setting, that incorporate both peripheral pain and somatic symptoms. New and old criteria should coexist; they enable a major comprehension and ease the management of this prevalent disease (AU)

New diagnostic criteria for fibromyalgia: Here to stay?

OBJECTIVES: To assess the percentage of patients that fulfill the American College of Rheumatology (ACR) 1990 as well as the ACR 2010 classification criteria, to evaluate whether there is a correlation between tender points and the Widespread Pain Index (WPI) as well as signs and symptoms that predict a fibromyalgia (FM) subtype and to identify those which have greater impact on functioning. MATERIALS AND METHODS: We performed a cross-sectional comparative study of 206 patients with previous clinical diagnosis of FM. The studied variables were age, sex, years of disease, tender points, control points, WPI, Symptom Severity Score, subtype of FM, presence of other rheumatic disorders and the Fibromyalgia Impact Questionnaire (FIQ) score. RESULTS: The new diagnostic criteria of FM correctly classified 87,03% of patients who satisfied the ACR 1990 criteria. Both criteria were equally effective in assessing the impact of the disease. FM had a severe impact on the quality of life in 74,87% of patients. Somatoform disorder was the predominant subtype. Hyperalgesic FM had a significantly lower FIQ score than the somatoform disorder and depressive subtypes. CONCLUSION: The ACR 2010 criteria are a simple evaluation tool to use in the primary care setting, that incorporate both peripheral pain and somatic symptoms. New and old criteria should coexist; they enable a major comprehension and ease the management of this prevalent disease.

Urticaria pigmentosa-mastocitosis sistémica / Urticaria pigmentosa/systemic mastocytosis

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[Disseminated histoplasmosis and AIDS in an Argentine hospital: clinical manifestations, diagnosis and treatment]. / Histoplasmosis diseminada y sida en un hospital argentino: manifestaciones clínicas, diagnóstico y tratamiento.

We describe 16 HIV-infected patients with disseminated histoplasmosis (14 men, mean age 28 +/- 7.84 years), diagnosed at Hospital Eva Perón in Argentina during the period of October 1993 to July 2000. Disseminated histoplasmosis occurred in 5.3% of HIV-infected patients over the study period. The main symptoms included fever, weight loss and hepatosplenomegaly in 93.8%. Other relevant findings were respiratory compromise (56.3%), digestive symptoms (43.8%), mucocutaneous lesions (75%) and multiple lymphadenopathy (69%). Treatment consisted of amphotericin B 1 mg/kg/day up to a total dose of 1 g, followed by 400 mg/day of oral itraconazole. Mortality in the acute phase was 19% and 37.5% of patients relapsed.