Moderate Traumatic Brain Injury in Adult Population: The Latin American Brain Injury Consortium Consensus for Definition and Categorization.

Moderate traumatic brain injury (TBI) is a diagnosis that describes diverse patients with heterogeneity of primary injuries. Defined by a Glasgow Coma Scale between 9 and 12, this category includes patients who may neurologically worsen and require increasing intensive care resources and/or emergency neurosurgery. Despite the unique characteristics of these patients, there have not been specific guidelines published before this effort to support decision-making in these patients. A Delphi consensus group from the Latin American Brain Injury Consortium was established to generate recommendations related to the definition and categorization of moderate TBI. Before an in-person meeting, a systematic review of the literature was performed identifying evidence relevant to planned topics. Blinded voting assessed support for each recommendation. A priori the threshold for consensus was set at 80% agreement. Nine PICOT questions were generated by the panel, including definition, categorization, grouping, and diagnosis of moderate TBI. Here, we report the results of our work including relevant consensus statements and discussion for each question. Moderate TBI is an entity for which there is little published evidence available supporting definition, diagnosis, and management. Recommendations based on experts' opinion were informed by available evidence and aim to refine the definition and categorization of moderate TBI. Further studies evaluating the impact of these recommendations will be required.

Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad / Clinical Practice Guideline for the management of community-acquired pneumonia

Resumen La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.

Abstract Pneumonia continues to be one of the main causes of consultation and hospitalization to which, besides its high impact on morbidity and mortality, the current problem of antimicrobial resistance is added; thus, establishing guidelines that allow its adequate diagnosis and treatment is of great importance to obtain better clinical outcomes and promote a rational use of antibiotics in these patients. This clinical practice guideline (CPG) contains evidence-based recommendations for the diagnosis and treatment of community-acquired pneumonia in adult population; these recommendations were made by means of the process of adaptation of evidence-based CPGs for the Colombian context.

Factors Associated with Mortality in Patients with Autoimmune Diseases Admitted to the Intensive Care Unit in Bogota, Colombia.

Patients with autoimmune diseases (ADs) are a challenge for the intensivist; it is hard to differentiate among infection, disease activity, and combinations of both, leading to high mortality. This study is a retrospective analysis of 124 critically ill patients admitted to the intensive care unit (ICU) in a university hospital between 2008 and 2016. Bivariate case-control analysis was performed, using patients who died as cases; later, analysis using a logistic regression model with variables that were associated with mortality was conducted. Four variables were consistently associated with mortality in the logistic regression model and had adequate prediction value (Hosmer and Lemeshow statistic = 0.760; Nagelkerke R-squared = 0.494). The risk of death was found to be statistically associated with the following: shock at admission to ICU [odds ratio (OR): 7.56; 95% confidence interval (CI): 1.78-31.97, p = 0.006], hemoglobin level <8 g/dL (OR: 16.12; 95% CI: 3.35-77.52, p = 0.001), use of cytostatic agents prior to admission to the ICU (OR: 8.71; 95% CI: 1.23-61.5, p = 0.03), and low levels ofcomplement C3 (OR: 5.23; 95% CI: 1.28-21.35, p = 0.02). These variables can guide clinicians in the early identification of patients with AD with increased risk of death during hospitalization, leading to initial therapies seeking to improve survival. These results should be evaluated prospectively in future studies to establish their predictive power.

Evaluación de eficacia y seguridad del dilevalol en el tratamiento de la hipertensión arterial esencial / Safety and efficacy evaluation of dilevalolin essential hypertensive patients

El dilevalol, isómero óptico del labetalol, tiene efectos vasodilatador y beta-bloqueador, lo que previene la taquicardia refleja; con actividad agonista beta-2 intrínseca. Su escasa actividad alfa-bloqueadora conlleva menos hipotensión ortastática y mejor tolerancia a la primera dosis. Este trabajo evalúa su eficacia y seguridad comparándolo con captopril y nifedipina. Se estudiaron 58 pacientes con hipertensión arterial; después de una fase *placebo* de 2-3 semanas, se incluyeron pacientes con TA diastólica entre 95 y 105 mmHg. En la fase de *tratamiento activo* de 4 semanas, los pacientes fueron asignados aleatoreamente a uno de los 3 fármacos. Inicialmente 15 recibieron dilevalol 200mg/día. Con dilevalol la tensión arterial media (TAM) disminuyó del 118.0+-1.3 a 107.3+-2.7 mmHg en la cuarta semana de tratamiento, con captopril de 117.8+-1.2 a 108.6+-2.7 mmHg. (p<0.05). Cuando se comparó dilevalol con nifedipina, el dilevalol redujo la TAM de 116+-2.0 a 104.3+-3.0 (p<0.05). Ninguno presentó hipotensión ortostática y no hubo efectos secundarios importantes. Estos resultados demuestran que la eficacia y tolerancia de dilevalol es comparable a captopril y nifedipina en pacientes con hipertensión arterial esencial.

Mixoma del ventriculo derecho: informe de un caso clínico y revisión de la literatura / Right ventricular myxoma: a case report and review of the literature

Se estudió una paciente de 17 años de edad con manifestaciones clínicas de embolismo pulmonar. La ecocardiografía bidimensional mostró una masa tumoral intraventricular derecha. Se efectuó resección quirurgica y el estudio histopatológico lo catalogó como mixoma. Su evolución post-operatoria fué satisfactoria. Este es el primer caso de un mixoma intraventricular derecho diagnosticado en vida en nuestro hospital. Se revisa la bibliografia de esta infrecuente localización del tumor