Mortality Due to Acute Respiratory Distress Syndrome in Latin America.

OBJECTIVES: Mortality due to acute respiratory distress syndrome (ARDS) is a major global health problem. Knowledge of epidemiological data on ARDS is crucial to design management, treatment strategies, and optimize resources. There is ample data regarding mortality of ARDS from high-income countries; in this review, we evaluated mortality due to ARDS in Latin America. DATA SOURCES: We searched in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Science Literature databases from 1967 to March 2023. STUDY SELECTION: We searched prospective or retrospective observational studies and randomized controlled trials conducted in Latin American countries reporting ARDS mortality. DATA EXTRACTION: Three pairs of independent reviewers checked all studies for eligibility based on their titles and abstracts. We performed meta-analysis of proportions using a random-effects model. We performed sensitivity analyses including studies with low risk of bias and with diagnosis using the Berlin definition. Subgroup analysis comparing different study designs, time of publication (up to 2000 and from 2001 to present), and studies in which the diagnosis of ARDS was made using Pao2/Fio2 less than or equal to 200 and regional variations. Subsequently, we performed meta-regression analyses. Finally, we graded the certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation). DATA SYNTHESIS: Of 3315 articles identified, 32 were included (3627 patients). Mortality was 52% in the pooled group (low certainty of evidence). In the sensitivity analysis (according to the Berlin definition), mortality was 46% (moderate certainty of evidence). In the subgroup analysis mortality was 53% (randomized controlled trials), 51% (observational studies), 66% (studies published up to 2000), 50% (studies after 2000), 44% (studies with Pao2/Fio2 ≤ 200), 56% (studies from Argentina/Brazil), and 40% (others countries). No variables were associated with mortality in the meta-regression. CONCLUSIONS: ARDS mortality in Latin America remains high, as in other regions. These results should constitute the basis for action planning to improve the prognosis of patients with ARDS (PROSPERO [CRD42022354035]).

Evaluación del riesgo cardiovascular en trabajadores de institución financiera de la ciudad de Guatemala / Evaluation of the cardiovascular risk in workers of financial institution of the city of Guatemala

Las enfermedades cardiovasculares son una epidemia a nivel mundial y en países en vías de desarrollo, laincidencia y prevalencia han ido en aumento. Objetivo: El objetivo general fue determinar la prevalencia defactores de riesgo para el desarrollo de enfermedad cardiovascular en un grupo de personas económicamente activas. Métodos: Estudio descriptivo transversal que incluyó a todos los trabajadores de la institución que voluntariamente dieron una muestra de sangre y de orina, y se sometieron a una evaluación clínica durante los meses de junio de 2011 a julio del 2012. Resultados: incluimos 532 participantes, edad promedio 38años(19-65años), 69% de sexo masculino, 23% hipertensión arterial, 7% pre-hipertensión, 8% de tabaquismo, obesidad 16%, 36% sobrepeso, 35% hipercolesterolemia, 31% hipertrigliceridemia, 59% HDL<40mg/dl, 62% LDL >100mg/dl, glicemia preprandial alterada 4%, 14% hiperuricemia, 1% muy alto riesgocardiovascular, 17% alto riesgo. Conclusiones: Los factores de riesgo cardiovascular tienen una alta prevalencia en la población de estudio, a pesar de tratarse de una población joven.

Cardiovascular diseases are epidemic globally and in developing countries, the incidence and prevalence have increased. Objective: The objective was to determine the prevalence of risk factors for the development of cardiovascular disease in a group of economically active people. Methods: A cross sectional study that included all employees of the institution who voluntarily gave a blood sample and urine, and underwent a clinical evaluation during the months of June 2011 to July 2012. Results: We included 532 participants, meanage 38years (19-65años), 69%male, 23% hypertension, pre hypertension 7%, 8% smoking, obesity16%,36% overweight, 35% hypercholesterolemia, hypertriglyceridemia 31%, 59%HDL <40mg/dL, 62%LDL> 100mg/dl, altered fasting glucose4%, 14% hyperuricemia, 1% very high cardiovascular risk, 17% higher risk. Conclusions: Cardiovascular risk factors are highly prevalent in the study population, despite being a young population.

Interstitial lung disease related to rheumatoid arthritis: evolution after treatment

Objetivo: Describir la evolución de la función pulmonar en una cohorte de pacientes con enfermedad pulmonar intersticial asociada a la artritis reumatoide (EPI-AR), tratados de acuerdo al juicio de sus médicos tratantes. Métodos: Estudio de cohorte retrospectivo de pacientes con EPI-AR, demostrada con un patrón restrictivo en las pruebas de función pulmonar, y de enfermedad pulmonar intersticial en las tomografía de alta resolución (HRCT). Los pacientes tuvieron una evaluación basal de la función pulmonar que incluyó espirometría, DLCO y HRCT. En un mínimo de 4 meses, una segunda evaluación de la función pulmonar fue realizada. Todos los pacientes recibieron una dosis alta de prednisona (1 mg/kg/día) por 6 semanas con un esquema de reducción, con una dosis de prednisona de 10 mg/día a los 6 u 8 meses de seguimiento. Se prescribió metotrexate en 18/40 (45%) pacientes, leflunamida o azatioprina, o ambas en 22/40 (55%) pacientes. Resultados: Se identificaron 40 pacientes con EPI-AR, El patrón más frecuente en la HRCT fue el indeterminado, con imágenes reticulares y de vidrio despulido en un 50% de los casos. A los 4 meses de seguimiento se observó una mejoría de los valores de la capacidad vital forzada (CVF), mediana basal de 1.47 Lts, intervalo inter cuartil (IIC): 0.99-1.91 Lts., Vs. Mediana de 1.66 Lts., IIC:1.37-2.1 Lts., p < 0.004. Los pacientes con los puntajes menores de la escala de Kazerooni para fibrosis pulmonar, (< 0.47) fueron los que presentaron una mejoría en los valores de la CVF. Conclusion: Los pacientes con EPI-AR pueden tener una mejoría en la CVF después del tratamiento con dosis altas de corticosteroides y fármacos modificadores de la enfermedad. (FARMES) (AU)

Objective: To describe the evolution of lung function in a cohort of rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) treated according to the medical judgment of attending physicians. Methods: Retrospective cohort of RA patients with ILD, defined by a restrictive pattern in lung function tests and evidence of ILD in high resolution computed tomography (HRCT). Patients had an assessment of lung function including spirometry, diffusing capacity for carbon monoxide (DLCO), and HRCT. At a minimum of 4 months of follow up, a second assessment of lung function was done. All patients received a high dose of prednisone (1 mg/kg/day) scheme for 6 weeks with a reduction scheme ending with a dose of 10 mg/day of prednisone at about 6-8 months of follow up. Methotrexate was used in 18/40 (45%) patients and leflunomide or azathioprine or both were indicated in 22/40 (55%). Results: Forty patients were identified. An indeterminate pattern with diffuse ground glass and reticulation images (50%) was the most prevalent pattern on HRCT scans. At a minimum of 4 months of follow up, an improvement in basal FVC values was observed (median (IQR)) 1.47 Lts. (0.99-1.91) vs 1.66 Lts. (1.37-2.1)), P < 0.004. Patients with lower Kazerooni scores for fibrosis (<0.47) had a better improvement in the FVC values. Conclusions: Patients with RA and ILD may have an improvement in the FVC after a treatment with high doses of corticosteroids and disease modifying antirheumatic drugs (DMARDs) (AU)

Interstitial lung disease related to rheumatoid arthritis: evolution after treatment.

OBJECTIVE: To describe the evolution of lung function in a cohort of rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) treated according to the medical judgment of attending physicians. METHODS: Retrospective cohort of RA patients with ILD, defined by a restrictive pattern in lung function tests and evidence of ILD in high resolution computed tomography (HRCT). Patients had an assessment of lung function including spirometry, diffusing capacity for carbon monoxide (DLCO), and HRCT. At a minimum of 4 months of follow up, a second assessment of lung function was done. All patients received a high dose of prednisone (1 mg/kg/day) scheme for 6 weeks with a reduction scheme ending with a dose of 10 mg/day of prednisone at about 6-8 months of follow up. Methotrexate was used in 18/40 (45%) patients and leflunomide or azathioprine or both were indicated in 22/40 (55%). RESULTS: Forty patients were identified. An indeterminate pattern with diffuse ground glass and reticulation images (50%) was the most prevalent pattern on HRCT scans. At a minimum of 4 months of follow up, an improvement in basal FVC values was observed (median (IQR)) 1.47 Lts. (0.99-1.91) vs 1.66 Lts. (1.37-2.1)), P<0.004. Patients with lower Kazerooni scores for fibrosis (<0.47) had a better improvement in the FVC values. CONCLUSIONS: Patients with RA and ILD may have an improvement in the FVC after a treatment with high doses of corticosteroids and disease modifying antirheumatic drugs (DMARDs).

Tuberculosis renal / Genitourinary tuberculosis

Paciente femenina de 62 años que consultó por dolor lumbar crónico y fiebre, en quien se diagnosticaban infecciones urinarias a repetición y cuadros de litiasis renal. Se realizaron baciloscopías en orina observándose bacilos ácido alcohol resistentes. La tuberculosis renal es una patología poco frecuente, representa apenas el 3% de las formas extrapulmonares y el diagnóstico se basa en una alta sospecha clínica.