Boosting the Beat: A Critical Showdown of Levosimendan and Milrinone in Surgical and Non-Surgical Scenarios: A Narrative Review.

Acute heart failure, advanced cardiac failure, cardiac surgery, and sepsis are conditions that require simultaneous treatment to stimulate contractility and/or reduce systemic vascular resistance, with levosimendan and milrinone being treatment options. This research's aim is to review the current indications and evidence for these medications across various scenarios. Evidence suggests that levosimendan is a non-inferior alternative to dobutamine and superior to milrinone in treating low cardiac output syndrome following cardiac surgery. In cases of septic shock, levosimendan has been linked to lower mortality rates compared to placebo, while milrinone's efficacy remains inconclusive. Furthermore, postoperative patients undergoing correction for congenital heart disease have shown reduced mechanical ventilation time and intensive care unit stays when treated with levosimendan, although differences exist between the populations assigned to each intervention. In conclusion, levosimendan, compared to milrinone, appears to offer better hemodynamic favorability in patients undergoing cardiac surgery. However, additional research is necessary to further understand its impact on hemodynamic outcomes, mortality, intensive care unit, and hospital stays in patients with cardiogenic shock of both ischemic and non-ischemic etiologies, as well as septic shock.

Fiberoptic Endoscopy Evaluation of Swallowing (FEES) Findings Associated with High Pneumonia Risk in a Cohort of Patients at Risk of Dysphagia.

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

Survival at 3, 6 and 12 months in patients diagnosed with community-acquired pneumonia in Colombia: a retrospective cohort study.

BACKGROUND: The primary aim of this study is to assess the survival rates of individuals diagnosed with Community-Acquired Pneumonia (CAP) post-hospitalization in Colombia. Additionally, explore potential risk factors associated with decreased long-term survival. METHODS: A retrospective cohort study was conducted in a hospital in Colombia, evaluating survival at 3, 6 and 12 months in CAP patients, using the Kaplan-Meier method. Stratifications were made by age, sex, comorbidity, and severity. The comparison of survival curves was performed using the Log-Rank test, a multivariate analysis with Cox regression was performed to study possible risk factors that affected 12-month survival in patients with CAP. RESULTS: 3688 subjects were admitted, with a mortality of 16.3 % per year. Survival at three, six, and twelve months was 92.9 % (95 % CI 92-93 %), 88.8 % (95 % CI 87-90 %), and 84.2 % (95 % CI 82-85 %), respectively. Analysis stratified by pneumonia severity index, 12-month survival was 98.7 % in Class I, 95.6 % in Class II, 87.41 % in Class III, 77.1 % in Class IV, and 65.8 % in class-V (p < 0.001). Cox-regression showed that being male (HR = 1.44; 95 % CI 1.22‒1.70; p < 0.001), an elevated pneumonia severity index (HR = 4.22; 95 % CI 1.89‒9.43; p < 0.001), a high comorbidity index (HR = 2.29; 95 % CI 1.89‒2.84; p < 0.001) and vasopressor requirement (HR = 2.22; 95 % CI < 0.001) were associated with a lower survival at twelve months of follow-up. CONCLUSION: Survival in patients with CAP who require hospitalization decreases at 3, 6, and 12 months of follow-up, being lower in patients older than 65 years, men, high comorbidity, and in subjects with severe presentation of the disease.

Curve-Modelling and Machine Learning for a Better COPD Diagnosis.

Background: Development of new tools in artificial intelligence has an outstanding performance in the recognition of multidimensional patterns, which is why they have proven to be useful in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Methods: This was an observational analytical single-centre study in patients with spirometry performed in outpatient medical care. The segment that goes from the peak expiratory flow to the forced vital capacity was modelled with quadratic polynomials, the coefficients obtained were used to train and test neural networks in the task of classifying patients with COPD. Results: A total of 695 patient records were included in the analysis. The COPD group was significantly older than the No COPD group. The pre-bronchodilator (Pre BD) and post-bronchodilator (Post BD) spirometric curves were modelled with a quadratic polynomial, and the coefficients obtained were used to feed three neural networks (Pre BD, Post BD and all coefficients). The best neural network was the one that used the post-bronchodilator coefficients, which has an input layer of 3 neurons and three hidden layers with sigmoid activation function and two neurons in the output layer with softmax activation function. This system had an accuracy of 92.9% accuracy, a sensitivity of 88.2% and a specificity of 94.3% when assessed using expert judgment as the reference test. It also showed better performance than the current gold standard, especially in specificity and negative predictive value. Conclusion: Artificial Neural Networks fed with coefficients obtained from quadratic and cubic polynomials have interesting potential of emulating the clinical diagnostic process and can become an important aid in primary care to help diagnose COPD in an early stage.

Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19.

BACKGROUND: Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. METHODS: A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. RESULTS: A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546-0.632) and 0.567 (95% CI: 0.526-0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628-0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582-0.667) and 0.706 (95% CI: 0.669-0.742), respectively. CONCLUSION: PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19.

Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study.

Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.

Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin - propensity score matching study.

BACKGROUND: Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE. METHODS: A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test. RESULTS: Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61). CONCLUSION: In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.

The Challenges of Spirometric Diagnosis of COPD.

Chronic obstructive pulmonary disease (COPD) is one of the top causes of morbidity and mortality worldwide. Although for many years its accurate diagnosis has been a focus of intense research, it is still challenging. Due to its simplicity, portability, and low cost, spirometry has been established as the main tool to detect this condition, but its flawed performance makes it an imperfect COPD diagnosis gold standard. This review aims to provide an up-to-date literature overview of recent studies regarding COPD diagnosis; we seek to identify their limitations and establish perspectives for spirometric diagnosis of COPD in the XXI century by combining deep clinical knowledge of the disease with advanced computer analysis techniques.

Validity of the ROX index in predicting invasive mechanical ventilation requirement in pneumonia.

BACKGROUND: The ROX index (Respiratory rate-OXygenation) has been described as a prediction tool to identify the need for invasive mechanical ventilation (IMV) in community-acquired pneumonia (CAP) with acute hypoxaemic respiratory failure treated with high-flow nasal cannula in order to avoid delay of a necessary intubation. However, its use in predicting the need for ventilatory support in hospitalised patients with CAP has not been validated. METHODS: This is a retrospective cohort study including subjects with CAP treated in the general ward, emergency service or intensive care unit of a third-level centre in Cundinamarca, Colombia, between January 2001 and February 2020. The ROX index was estimated as the ratio of oxygen saturation/fraction of inspired oxygen to respiratory rate. RESULTS: A total of 895 patients were included, of whom 93 (10%) required IMV. The ROX index proved to be a good predictor, presenting an area under the curve of receiver operating characteristics (AUROC) of 0.733 (95% CI 0.671 to 0.795, p<0.001) when determined by pulse oximetry and an AUROC of 0.779 (95% CI 0.699 to 0.859, p<0.001) when estimated by arterial blood gas (ABG) parameters, with an intraclass correlation of 0.894. The estimated cut-off point was 14.8; a score less than 14.8 indicates high risk of requiring IMV. CONCLUSION: The ROX index is a good predictor of IMV in hospitalised patients with CAP. It presents good performance when calculated through pulse oximetry and can replace the one calculated by ABG.

Granulomatosis with polyangiitis: A case report of early systemic fulminant presentation

Granulomatosis with polyangiitis is a systemic vasculitis that affects medium and small vessels, with high expression of anti-neutrophil cytoplasmic autoantibody. A case is pre sented on a patient with an initial compromise of the lower airway, who did not respond to management, required intensive care unit management, and died due to severe diffuse alveolar hemorrhage. His definitive diagnosis was established with a clinical autopsy. Gran-ulomatosis with polyangiitis is a disease with different ways of presentation, and can have fatal outcomes if it is not diagnosed early.

La granulomatosis con poliangeítis es un tipo de vasculitis que afecta a vasos de mediano y pequeño calibre de manera sistémica, con una alta expresión de anticuerpos contra el citoplasma del neutrófilo. Se presenta el caso de un paciente con un compromiso inicial de la vía área inferior, que no respondió al tratamiento y requirió manejo en unidad de cuidados intensivos. Finalmente, falleció por una hemorragia alveolar difusa severa. Su diagnóstico definitivo se estableció con una autopsia clínica. La granulomatosis con poliangeítis tiene diferentes formas de presentación y puede tener desenlaces fatales si no se diagnostica a tiempo.

Validación y reproducibilidad intraevaluador de la escala CDQ para el diagnóstico de EPOC en Colombia / Validation and intrarater reliability of the CDQ scale for the diagnosis of COPD in Colombia

Introducción: la EPOC es altamente subdiagnosticada, por lo que aplicar escalas de predicción clínica como el COPD Diagnostic Questionnaire (CDQ) ayuda a abordar este problema. Sin embargo, se desconoce su rendimiento en nuestra población. Objetivo: evaluar la validez de criterio y reproducibilidad intraevaluador del CDQ en una población colombiana. Materiales y métodos: estudio de cohorte prospectivo. La reproducibilidad se valoró con el estadístico Kappa y el coeficiente de correlación intraclase (CCI). La validez se estableció con el puntaje obtenido del cuestionario CDQ y los valores espirométricos VEF1/CVF 16,5 y < 19,5 y probabilidad alta de EPOC CDQ ≥ 19,6. El ACOR fue de 0,68 (IC95%: 0,647-0,712) y se obtuvo una sensibilidad del 79% y una especificidad del 44% para un puntaje ≥ 16,5, con un VPP del 26% y un VPN del 86%. Conclusiones: el cuestionario CDQ tiene un rendimiento regular para el diagnóstico de la EPOC con una ACOR similar a otros cuestionarios, puede ser útil en pacientes subdiagnosticados y el punto de corte óptimo para esta población fue de 16,5.

Summary Background: COPD is highly underdiagnosed, thus applying clinical prediction scales such as the COPD Diagnostic Questionnaire (CDQ) helps to address this problem. Objective: To evaluate the criterion validity and intra-rater reproducibility of the questionnaire CDQ in a Colombian population. Materials and methods: A prospective cohort study. The reproducibility was assessed with the Kappa statistic and the intraclass correlation coefficient (ICC). Validity was established with the score obtained from the CDQ questionnaire and the spirometry values (FEV1/ FVC 16.5 and < 19.5, and high probability of CDQ COPD ≥ 19.6. The ACOR was 0.68 (95%CI: 0.647-0.712), a sensitivity of 79% and a specificity of 44% were obtained for a score ≥16.5, with a PPV of 26% and a NPV of 86%. Conclusions: The CDQ questionnaire has a regular performance for the diagnosis of COPD with an ACOR similar to other questionnaires, it can be useful in underdiagnosed patients. The optimal cut-off point for this population was 16.5.

Quality of life at 3 and 6 months in military personnel with a history of thoracic trauma suffered in combat.

OBJECTIVE: To measure the score and variation in the SF-36 quality of life questionnaire at 3 and 6 months of evaluation in military personnel with a history of chest trauma in combat. METHOD: Comparative study between military with chest trauma and healthy military personnel from 2011 to 2016, evaluating the SF-36 quality of life questionnaire. RESULTS: 45 subjects were analyzed, 25 with a history of chest trauma and 10 healthy controls with combat experience. 25 of the cases were evaluated at 3 months and 11 at 6 months. The average age was 28.2 years (standard deviation: 7.22), and 76% had projectile wounds with a high-speed firearm. 44 % (11/25) of the subjects with chest trauma at three months of assessment presented a lot of limitation for the performance of moderate activities (p < 0.001) and only 5% (1/20) of the controls reported a lot of limitation (p < 0.001). CONCLUSIONS: There is significant deterioration in the quality of life in all domains through the SF-36 questionnaire in patients with chest trauma at 3 and 6 months after the evaluation.

OBJETIVO: Medir el puntaje y la variación en el cuestionario de calidad de vida SF-36 a los 3 y 6 meses de valoración en militares con antecedente de trauma de tórax en combate. MÉTODO: Estudio comparativo entre militares con trauma de tórax y militares sanos entre los años 2011 y 2016, evaluando el cuestionario de calidad de vida SF-36. RESULTADOS: Se analizaron 45 sujetos, 25 con antecedente de trauma de tórax y 10 controles sanos con experiencia en combate. De los sujetos con trauma, 25 se evaluaron a los 3 meses y 11 a los 6 meses. El promedio de edad fue de 28.2 años (desviación estándar: 7.22). El 76% tuvieron heridas por proyectil con arma de fuego de alta velocidad. El 44% (11/25) de los sujetos con trauma de tórax, a los 3 meses de valoración, presentaba mucha limitación para la realización de actividades moderadas (p < 0.001) y solo el 5% (1/20) de los controles referían mucha limitación (p < 0.001). CONCLUSIONES: Hay un deterioro significativo en la calidad de vida en todos los dominios del cuestionario SF-36 en pacientes con trauma de tórax a los 3 y 6 meses de la valoración.

Validación de un puntaje pronóstico para malaria complicada / Validation of a prognostic score for complicated malaria

Introducción: El reconocimiento temprano de los sujetos con malaria que pueden desarrollar complicaciones es fundamental para orientar el tratamiento. Se requiere un instrumento de predicción basado en características clínicas para predecir las complicaciones. Objetivo: Desarrollar y validar una herramienta de predicción clínica y paraclínica para predecir malaria complicada. Métodos: Se reclutaron de manera secuencial sujetos con diagnóstico de malaria complicada según criterios de la Organización Mundial de la Salud. Las características clínicas que se asociaron a malaria complicada fueron identificadas e incorporadas en un modelo de predicción logístico binario en una cohorte inicial de derivación y posteriormente validadas en una cohorte diferente de sujetos con la infección. Resultados: Se analizaron 584 sujetos en la cohorte de derivación y 898 en la cohorte de validación. La incidencia de malaria complicada fue de 21,2 por ciento y 10,9 por ciento, respectivamente. Las variables asociadas con malaria complicada fueron la disnea, fiebre por más de 72 horas, hemoglobina < 13 mg/dL, bilirrubina total > 6 mg/dL, nitrógeno ureico > 20 mg/dL, y Plasmodium vivax. El área bajo la curva de características operativas del receptor para el puntaje construido con estas variables en la cohorte de derivación fue de 0,70 y en la cohorte de validación fue de 0,69. Conclusión: Un puntaje pronóstico en pacientes con malaria que evalúe la presencia de disnea, fiebre persistente, nivel de hemoglobina, bilirrubina total, nitrógeno ureico e infección por P. vivax puede ser útil para clasificar de manera oportuna y objetiva a los sujetos que pueden desarrollar complicaciones(AU)

Introduction: Early identification of subjects with malaria who may develop complications is critical to guide treatment. A predictive tool based on the clinical characteristics of the disease is required to predict complications. Objective: To develop and validate a clinical and paraclinical tool to predict complicated malaria. Methods: Subjects with a diagnosis of complicated malaria according to the World Health Organization criteria were sequentially recruited. Clinical characteristics associated with complicated malaria were identified and incorporated into a binary logistic prediction model in an initial derivation cohort and, subsequently, validated in a different cohort of subjects with the infection. Results: 584 subjects were analyzed in the derivation cohort and 898 in the validation cohort. The incidence of complicated malaria was 21.2 percent and 10.9 percent, respectively. Variables associated with complicated malaria were dyspnea, fever for more than 72 hours, hemoglobin < 13 mg/dL, total bilirubin > 6 mg/dL, urea nitrogen > 20 mg/dL and Plasmodium vivax. The area under the receiver operating characteristics curve for the score constructed with these variables in the derivation cohort was 0.70 and in the validation cohort, it was 0.69. Conclusion: A prognostic score that evaluates the presence of dyspnea, persistent fever, hemoglobin level, total bilirubin, urea nitrogen and P. vivax infection in patients with malaria may be useful to classify in a timely and objective manner subjects who may develop complications(AU)

Sobrevida en una cohorte con diagnóstico de tuberculosis en Colombia / Survival at cohort diagnosed with tuberculosis in Colombia

Introducción: La tuberculosis es una patología infecciosa crónica cuya incidencia es elevada en países en vía de desarrollo, sin embargo, es limitada la información y los estudios que analizan la mortalidad y sobrevida a largo plazo. Metodología: estudio de cohorte retrospectivo, en pacientes con diagnóstico de tuberculosis mayores de 18 años, el ingreso fue de manera consecutiva hasta completar el periodo de estudio. Se analizó la sobrevida y mortalidad a través del estimador Kaplan ­ Meier por la prueba de log Rank. Resultados: ingresaron 329 sujetos, la mortalidad a los 30 días fue de 11,9% y al año del 24,6%, la tuberculosis pulmonar fue el tipo más frecuente con en el 70,2%. Los hallazgos al examen físico relacionados con mortalidad fueron la caquexia (p<0,001) y el edema en extremidades (p<0,001). La sobrevida general fue del 87,2% a los 30 días y del 72,9% al año. En los pacientes con tuberculosis pulmonar la sobrevida fue del 85,8% a los 30 días y del 72,8% al año. Conclusión: La tasa de sobrevida a un año en pacientes hospitalizados por tuberculosis es baja, la edad avanzada, desnutrición, PaO2/FiO2 menor de 300, proteína c reactiva mayor de 45 mg/dL, enfermedad cerebrovascular y enfermedad vascular periférica fueron variables que se asociaron con una mayor mortalidad(AU)

Background: Tuberculosis is a chronic infectious pathology whose incidence is high in developing countries, however, information and studies that analyze mortality and long-term survival are limited. Methodology: retrospective cohort study, in patients with a diagnosis of tuberculosis older than 18 years, admission was consecutive until completing the study period. Survival and mortality were analyzed using the Kaplan-Meier estimator by the log Rank test. Results: 329 subjects were admitted, mortality at 30 days was 11.9% and at one year 24.6%, pulmonary tuberculosis was the most frequent type with 70.2%. Physical examination findings related to mortality were cachexia (p<0.001) and extremity edema (p<0.001). Overall survival was 87.2% at 30 days and 72.9% at one year. In patients with pulmonary tuberculosis, survival was 85.8% at 30 days and 72.8% at one year. Conclusion: The one-year survival rate in patients hospitalized for tuberculosis is low, advanced age, malnutrition, PaO2/FiO2 less than 300, c-reactive protein greater than 45 mg/dL, cerebrovascular disease and peripheral vascular disease were variables that were associated with higher mortality(AU)

Importancia de los virus en las exacerbaciones de Enfermedad Pulmonar Obstructiva Crónica (EPOC). ¿Podría cambiar su comportamiento durante la pandemia de SARS-COV-2 (COVID-19)? / Importance of Viruses in Exacerbations of Chronic Obstructive Pulmonary Disease (COPD). Could Change its Behavior During the SARS-COV-2 (COVID-19) pandemic? / Importância dos vírus nas exacerbações da Doença Pulmonar Obstrutiva Crónica (DPOC). Poderia mudar seu comportamento durante a pandemia de SARS-COV-2 (COVID-19)?

Resumen: La pandemia por SARS-COV-2 ha generado muchos interrogantes sobre el comportamiento de enfermedades crónicas. Si bien se conoce que los pacientes con comorbilidades importantes tienen un mayor riesgo de complicaciones, no se conoce el comportamiento de enfermedades, como la enfermedad pulmonar obstructiva crónica (EPOC), en el período de pandemia y cuarentena por COVID-19. En este artículo, se realizó una revisión de la literatura sobre los principales aspectos teóricos para entender las posibles interacciones entre la infección por SARS-COV-2 y pacientes con patología respiratoria como la EPOC. Se revisaron los principales aspectos de las infecciones virales y su fisiopatología en la exacerbación de la enfermedad, sus mecanismos inflamatorios, y las condiciones que pueden aumentar el riesgo de infección y gravedad durante la pandemia por COVID-19. Además, se exploraron los aspectos relacionados a la cuarentena y su posible influencia sobre la exacerbación de la enfermedad. Finalmente, se exploraron los aspectos económicos relacionados con la exacerbación y su manejo asociado a la pandemia.

Abstract: The SARS-COV-2 pandemic has raised many questions about the behavior of chronic diseases. Although it is known that patients with significant comorbidities have a higher risk of complications, the behavior of diseases, such as chronic obstructive pulmonary disease (COPD), during the period of the COVID-19 pandemic and quarantine is not known. In this article, a literature review was carried out on the main theoretical aspects to understand the possible interactions between SARS-COV-2 infection and patients with respiratory pathology such as COPD. The main aspects of viral infections and their pathophysiology in the exacerbation of the disease, their inflammatory mechanisms, and the conditions that can increase the risk of infection and severity during the COVID-19 pandemic were reviewed. In addition, aspects related to quarantine and its possible influence on the exacerbation of the disease were explored. Finally, the economic aspects related to the exacerbation and its management associated with the pandemic were explored.

Resumo: A pandemia de SARS-COV-2 tem gerado muitos questionamentos sobre o comportamento das doenças crônicas. Embora se saiba que pacientes com comorbidades significativas apresentam risco aumentado de complicações, o comportamento de doenças como a doença pulmonar obstrutiva crónica (DPOC) não é conhecido. No período de pandemia e quarentena por COVID-19. Neste artigo, foi realizada urna revisão da literatura sobre os principais aspectos teóricos para compreender as possíveis interações entre a infecção por SARS-COV-2 e pacientes com patologia respiratória, como DPOC. Foram revisados os principais aspectos das infecções virais e sua fisiopatologia na exacerbação da doença, seus mecanismos inflamatórios e as condições que podem aumentar o risco de infecção e gravidade durante a pandemia COVID-19. Além disso, foram explorados aspectos relacionados à quarentena e sua possível influencia na exacerbação da doença. Por fim, foram explorados os aspectos económicos relacionados à exacerbação e sua gestão associada à pandemia.

Validación y reproducibilidad del cuestionario COPD-PS para la tamización de la EPOC: Bogotá, Colombia / Validation and reproducibility of the COPD-PS questionnaire for the screening of COPD: Bogotá, Colombia

Resumen Introducción: La enfermedad pulmonar obstructiva crónica es una afección con alta prevalencia a nivel mundial. Prevenible y tra table, pero con niveles de sub-diagnóstico muy altos. Es imperioso la utilización de herramientas de tamización; de fácil aplicación, interpretación y validadas en diferentes poblaciones, que ayudan no solo al clínico a la sospecha diagnostica, sino también al paciente a tomar conciencia sobre su enfermedad. Se busca validar el cuestionario COPD-Population Screener Questionnaire (COPD- PS) en una población colombiana. Materiales y métodos: Se realizó un estudio de cohorte prospectivo. Los participantes debían ser mayores de 40 años, tener una espirometría de buena calidad y haber realizado el cuestionario COPD-PS en dos oportunidades. La EPOC fue definida como un VEF1/ CVF < 0,7 y el antecedente de exposición a cigarrillo. Se realizó un análisis de reproducibilidad y validez. Resultado: De un total de 2199 sujetos potenciales, 1662 ingresaron al análisis final; la prevalencia de la EPOC en el estudio fue de 21,1%. Con el punto de corte de cuatro del cuestionario COPD-PS la sensibilidad fue del 77,2% y la especificidad de 46,3% con un área bajo la curva de características operativas del receptor de: 0,66(IC95%:0,63-0,69) (p < 0,01). Se obtuvo un coeficiente de correlación intraclase de 0,817(IC95%:0,79-0,84) y un coeficiente kappa de: 0,45(IC95%:0,31-0,59) (p < 0,01). Conclusión: El cuestionario COPD-PS es una herramienta con alta sensibilidad y buena reproducibilidad para la tamización de la EPOC, y podría ser una herramienta que oriente a la toma de espirometría en la búsqueda de sujetos no diagnosticados con esta patología.

Validation and reproducibility of the COPD-PS questionnaire for the screening of COPD: Bogotá, Colombia

Abstract Introduction: Chronic obstructive pulmonary disease is a condition with high prevalence worldwide. It is preventable and treatable, but with very high levels of underdiagnosis. The use of screening tools is imperative. These tools are easily applied, interpreted, and validated in different populations and help not only the clinician to confirm the diagnostic suspicion, but also the patients to become aware of their disease. The objective is to validate the COPD-Population Screener Questionnaire (COPD-PS) in one Colombian population. Materials and Methods: A prospective cohort study was carried out. Participants had to be older than 40 years, show a good quality spirometry, and have completed the COPD-PS questionnaire twice. COPD was defined as FEV1/FVC < 0.7 and with a history of exposure to tobacco smoke. A reproducibility and validation analysis has been conducted. Result: Out of a total of 2.199 potential subjects, 1.662 entered the final analysis; the prevalence of COPD in the study was 21.1%. With the COPD-PS questionnaire cut-off point of four, the sensitivity was 77.2% and the specificity was 46.3%, with an area under the receiver operating characteristic curve of: 0.66 (95% CI: 0.63-0.69) (p<0.01). An intraclass correlation coefficient of 0.817 (95% CI: 0.79-0.84) and a kappa coefficient of: 0.45 (95% CI: 0.31-0.59) (p<0.01) were obtained. Conclusion: The COPD-PS questionnaire is a tool with high sensitivity and good reproducibility for the screening of COPD, and could suggest the use of a spirometry in subjects not diagnosed with this disease.

Trastorno de estrés postraumático en una cohorte de militares con trauma de guerra

RESUMEN Introducción: Las personas que forman parte de las fuerzas armadas a nivel mundial han sido susceptibles al desarrollo del trastorno de estrés postraumático, debido a la exposición a condiciones que predisponen su desarrollo. Objetivo: Establecer la frecuencia y posibles factores de riesgo asociados del trastorno de estrés postraumático en sujetos con lesiones en tórax, sufridas en combate. Métodos: Estudio comparativo entre sujetos con trauma de tórax sufrido en combate y militares sin lesión torácica con experiencia en combate, mediante la evaluación de un cuestionario diagnóstico de 24 preguntas, validado para Colombia del trastorno de estrés postraumático. Se incluyó población militar de mayores de 18 años y menores de 55 años, con trauma de tórax que tuvieron manejo médico o quirúrgico (toracotomía o laparotomía). Resultados: Ingresaron al estudio 45 sujetos, 25 con antecedente de trauma de tórax y 20 sanos con experiencia en combate. De los sujetos con trauma, 25 se evaluaron a los 3 meses y 11 a los 5 meses. En los sujetos heridos en combate el promedio de edad fue de 24,1 años (DE: 4,99). A los 3 meses de valoración, el 36 % (p= 0,025) de los sujetos con antecedente de trauma de tórax cumplían criterios diagnósticos de trastorno de estrés postraumático, lo cual evidencia un aumento del 9,5 % a los 6 meses de seguimiento. Conclusión: Existe mayor frecuencia del trastorno de estrés postraumático en sujetos expuestos a eventos traumáticos de tórax en áreas de conflictos armados. La corta edad y los bajos niveles educativos podrían ser factores asociados a la aparición del trastorno.

ABSTRACT Introduction: People who are part of the armed forces worldwide have been susceptible to the development of post-traumatic stress disorder, due to exposure to conditions that predispose its development. Objective: To establish the frequency and possible associated risk factors of post-traumatic stress disorder in subjects with chest injuries, suffered in combat. Methods: Comparative study between subjects with chest trauma suffered in combat and military without thoracic injury with experience in combat, by evaluating a 24-question diagnostic questionnaire, validated for Colombia, of post-traumatic stress disorder. Military population older than 18 years and younger than 55 years, with chest trauma who underwent medical or surgical management (thoracotomy or laparotomy) were included. Results: 45 subjects entered the study, 25 with a history of chest trauma and 20 healthy with combat experience. Of the trauma subjects, 25 were evaluated at 3 months and 11 at 5 months. In the subjects wounded in combat, the average age was 24,1 years (SD: 4,99). At the 3-month evaluation, 36 % (p = 0,025) of the subjects with a history of chest trauma met the diagnostic criteria for post-traumatic stress disorder, which shows an increase of 9,5 % at the 6-month follow-up. Conclusion: There is a higher frequency of post-traumatic stress disorder in subjects exposed to traumatic chest events in areas of armed conflict. Young age and low educational levels could be factors associated with the appearance of the disorder.

Riesgo de desarrollar LIE-AG en pacientes con tamizaje inicial positivo para VPH y citología cervicovaginal negativa en seguimiento hasta 10 años: revisión sistemática y metaanálisis / Risk of developing H-SIL in patients with initial positive screening for HPV and negative cervicovaginal cytology in follow-up up to 10 years: systematic review and meta-analysis

Resumen Introducción: El cáncer de cérvix es el segundo en frecuencia y el tercero en mortalidad; la infección por el virus del papiloma humano (VPH) está asociada al riesgo de cáncer; sin embargo, no se conoce el riesgo acumulado a 1, 2, 3, 5 y 10 años. Objetivo: Determinar el riesgo de las pacientes VPH positivo con evaluación inicial citológica negativa para desarrollar lesión intraepitelial de alto grado a lo largo del tiempo. Método: Se realizó una revisión sistemática de artículos en inglés y español de los últimos 20 años, usando las bases de datos PubMed, Cochrane, LILACS, ProQuest y Embase. Se incluyeron ensayos clínicos aleatorizados en los que se determinaba el estado VPH y se realizaba seguimiento con citología cervicovaginal a 1, 2, 3, 5 y 10 años en mujeres de 20-64 años. Resultados: Se incluyeron siete ensayos clínicos aleatorizados, con un total de 98.521 mujeres, de ellas 8820 VPH positivo y 89.701 VPH negativo al ingreso, seguidas hasta por 10 años con citología cervicovaginal, encontrando que la infección por VPH es un factor de riesgo para desarrollar lesiones intraepiteliales de alto grado a 2, 5 y 10 años, con un riesgo relativo de 110.94 (79.41-154.97), 83.65 (55.22-126.73) y 29.71 (5.72-154.33), respectivamente. Conclusiones: La infección por VPH es un factor de riesgo importante para el desarrollo de lesiones intraepiteliales de alto grado a 2, 5 y 10 años.

Abstract Introduction: Cervical cancer is the second in frequency and the third in mortality, infection by the human papillomavirus (HPV) is associated with the risk of increased cancer; however, the cumulative risk of 1, 2, 3, 5 and 10 years is not known. Objective: To determine the risk of HPV-positive patients with negative initial cytological evaluation for developing high-grade intraepithelial lesion over time. Method: A systematic review of articles in English and Spanish in the last 20 years was carried out, using the PubMed, Cochrane, LILACS, ProQuest and Embase databases. Randomized clinical trials were included in which HPV was performed and subsequent follow-up with cervicovaginal cytology at 1, 2, 3, 5 and 10 years in women aged 20-64 years. Results: Seven randomized clinical trials were included, a total of 98,521 women, 8820 with positive HPV and 89701 negative on admission and followed up for up to 10 years with cervicovaginal cytology. Finding that HPV infection is a risk factor for developing high-grade intraepithelial lesion at 2, 5 and 10 years with a relative risk of 110.94 (79.41-154.97), 83.65 (55.22- 126.73) and 29.71 (5.72-154.33), respectively. Conclusions: HPV infection is an important risk factor for the development of high-grade intraepithelial lesion at 2, 5 and 10 years.

Validity of the Pulmonary Embolism Rule-Out Criteria (PERC) for ruling out pulmonary embolism in low-risk patients at high altitudes

Abstract Objectives: to validate the diagnostic yield of the PERC score for ruling out pulmonary embolism in low-risk patients at high altitudes (>2500 meters above sea level [ASL]). Methods: a cross-sectional study with diagnostic test analysis in patients over the age of 18 with suspected pulmonary embolism on admission or during hospitalization, who underwent chest computed tomography angiography between August 2009 and January 2020 in a tertiary care hospital located on the Bogotá savannah. The yield of the PERC score was assessed, calculated with an SaO2<95% and an SaO2<90% in patients with different risk levels according to the Wells, Geneva and Pisa scores for pulmonary embolism. Results: one thousand eighty-seven were included in the final analysis, 42% with PE. Patients classified as low-risk using the Wells score had a PERC ACOR calculated with SaO2<95% of 0.56 (95%CI:0.50-0.62) (p=0.049), and calculated with SaO2<90% of 0.60 (95%CI:0.54-0.66) (p=0.002). The ACOR for subjects classified as low-risk using the Geneva score, with a PERC calculated with SaO2<95%, was: 0.53 (95%CI:0.45-0.60) (p=0.459) and for a PERC calculated with SaO2<90% it was: 0.55 (95%CI:0.47-0.62) (P=0.218). The ACOR for subjects with a less than 10% probability of PE according to the Pisa score classification, with a PERC calculated with SaO2<95%, was: 0.54 (95%CI:0.44-0.64)(p=0.422), and for a PERC calculated with SaO2<90% it was: 0.56 (95%CI:0.46-0.66)(p=0.236). Conclusions: the PERC score calculated with an oxygen saturation <90% has a similar diagnostic yield to the PERC score calculated with an oxygen saturation <95% for ruling out PE in patients classified as low-risk by the Wells score at high altitudes (>2,500 meters ASL). (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2010).