Cardiac arrest in an emergency department in Colombia during 2011-2020: A descriptive study.

Background: Cardiac arrest is a public health problem related to high morbidity and mortality. In Colombia, objective data characterize in our population has been not available. The aim of this study has been to determined the epidemiological characteristics of patients with cardiorespiratory arrest treated in an emergency room. Methods: A retrospective observational cross-sectional cohort study was performed. We included adult patients admitted with a diagnostic of out-of-hospital cardiac arrest (OHCA) or who presented with in-hospital cardiac arrest while in the emergency department (ED). Results: A total of 415 patients were included 232 were men, and the median age was 67 years. OHCA was presented in 383 patients. In this group, 80.2% required orotracheal intubation, 90.1% received Epinephrine, and and 52.6% received immediate resuscitation. Survival after discharge was 43.1% in patients with non-shockable rhythm registered. Return of spontaneous circulation was achieved in 49.6%. The survival after hospital discharge was 22.2%. Cerebral performance category score <=2 was 20.4%. Conclusion: In our study, the epidemiological characteristics and outcomes of patients seen in the ED with cardiac arrest are similar to those described in the literature.

Emergency Thrombolysis During Cardiac Arrest Due to Pulmonary Thromboembolism: Our Experience Over 6 Years.

INTRODUCTION: Cardiac arrest (CA) is one of the leading causes of death worldwide. Among patients with CA, pulmonary embolism (PE) accounts for approximately 10% of all cases. OBJECTIVE: To compare the outcomes after cardiopulmonary-cerebral resuscitation (CCPR) with and without thrombolytic therapy (TT) in patients with CA secondary to PE. METHODS: We included patients older than 17 years admitted to our hospital between 2013 and 2017 with a diagnosis of CA with confirmed or highly suspected PE who received CCPR with or without TT. Measures of central tendency were used to depict the data. RESULTS: The study comprised 16 patients, 8 of whom received CCPR and thrombolysis with alteplase, whereas the remaining patients received CCPR without TT. The most frequent rhythm of CA in both groups was pulseless electrical activity. Return of spontaneous circulation (ROSC) occurred in 100% of patients who received TT and in 88% of non-thrombolysed patients. The mortality rate of patients who received TT and non-thrombolysed patients at 24 hours was 25% and 50%, respectively. However, at the time of hospital discharge, the mortality was the same in both groups (62%). In patients who received TT, mortality was related to sepsis and hemorrhage whereas in non-thrombolysed patients, mortality was due to myocardial dysfunction. CONCLUSION: Intra-arrest thrombolysis resulted in a higher likelihood of ROSC and a higher 24-hour survival in adults with CA secondary to acute PE. Overall, the survival at hospital discharge was the same in the two groups.

Equipos de trauma: realidad mundial e implementación en un país en desarrollo. Descripción narrativa / Trauma teams: global reality and implementation in a developing country. Narrative description

Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados «equipos de trauma¼. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano. Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos. Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma. Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo

Introduction. Trauma is one of the entities with the highest morbidity and mortality in the world. Teams specialized in trauma patient care are called «trauma teams¼. These teams arose from the need to provide timely multidisciplinary treatment to individuals with severe injuries in war; however, with time they moved to the civilian arena, generating a positive impact in terms of care times, mortality and morbidity. The objective of this study was to describe the process of development of trauma teams worldwide and the experience in our institution in southwestern Colombia. Methods. A search of the PUBMED database was carried out, which included systematic reviews, metaanalyses, Cochrane reviews, clinical trials, and case series.Results. Forty-one studies were included for this narrative review, and it was observed that the length of stay in the ER, the time of transfer to surgery, mortality and complications associated with trauma were lower when trauma teams are implemented. Discussion. The design of a horizontal care and assessment system for a patient with severe trauma produces a positive impact in terms of care times, mortality and morbidity. It is necessary to establish operational parameters in high and medium complexity health institutions in our country to implement such work teams

Caracterización clínica, bioquímica e imagenológica en una cohorte de pacientes diagnosticados con hiperglicinemia no cetósica clásica: estudio ambispectivo 2000-2014, Medellín, Colombia / Clinical, biochemical and imaging characterization in a cohort of patients diagnosed with classical nonketotic hyperglycinemia: ambispective study 2000-2014, Medellin-Colombia

Introducción: La hiperglicinemia no cetósica (HGNC) es un error innato del metabolismo del grupo de las aminoacidopatías, de carácter autosómico recesivo, causado por un defecto en el sistema de clivaje de la glicina. Es una entidad rara y no se conoce su incidencia en Colombia. Objetivo: Describir características clínicas, bioquímica e imagenológicas en una cohorte de pacientes diagnosticados con hiperglicinemia no cetósica clásica Materiales y métodos: Estudio de tipo descriptivo, ambispectivo, en el periodo enero 2000-2014, en varios centros de Medellín. Resultados: Se incluyeron 20 pacientes que cumplían criterios de inclusión, de los 35 pacientes que cumplían con el criterio de búsqueda, en su mayoría de sexo femenino y con un Apgar adecuado al nacer. El promedio de inicio de los síntomas fue de 2,6 días; somnolencia, hipoactividad, apnea, convulsiones y singulto fueron los principales síntomas, y las convulsiones de tipo focal las más frecuentes. La relación glicina LCR/plasma en promedio fue 0,42. El patrón estallido-supresión en el electroencefalograma y la ausencia o retraso en la mielinización de la sustancia blanca supratentorial en la resonancia magnética fueron hallazgos comunes. Conclusión: La HGNC es frecuente en nuestro medio, por lo cual es necesario que se disponga de pruebas bioquímicas y moleculares necesarias para diagnóstico oportuno, manejo integral y asesoría genética.

Introduction: Nonketotic Hyperglycinemia is an inborn error of metabolism in a group of aminoacidopathies, autosomal recessive, caused by a defect in the system of the glycine cleavage. It is rare, and the incidence is unknown in Colombia. Objective:To describe clinical, biochemical and imaging characteristics in a cohort of patients diagnosed with classical nonketotic hyperglycinemia. Materials and methods: This is a descriptive-ambispective study during the period January 2000 - 2014 in some centers of Medellin. Results: There were 35 patients who met the search criteria and finally 20 patients who met inclusion criteria. We found in this cohort more girls than boys, and most of them with a good APGAR. The average onset of symptoms was 2.6 days, with drowsiness, hypoactivity, apnea, seizures and singultus the main symptoms. The focal seizures were the most frequent type. The average value of CSF glycine to plasma glycine ratio was 0.42. The burst suppression pattern in the EEG and the absence or delayed myelination in the supratentorial white matter on MRI were common findings. All patients received dextromethorphan as part of their treatment and the vast majority of sodium benzoate. Conclusion: HGNC is common in our environment. It´s necessary to have available biochemical and molecular evidence for timely diagnosis, comprehensive management and genetic counseling.

Diabetes mellitus en pacientes con infarto agudo de miocardio en un hospital de alto nivel de complejidad de la ciudad de Medellín / Diabetes mellitus in patients with acute myocardial infarction in a high-complexity hospital of Medellin

Objetivo: describir las características clínicas y epidemiológicas de los pacientes con Infarto Agudo de Miocardio que tenían antecedente de Diabetes Mellitus. Metodología: estudio observacional, descriptivo y retrospectivo en el que se estudiaron 347 historias de pacientes mayoresde 18 años que presentaron infarto agudo de miocardio y que tenían antecedente confirmado de Diabetes Mellitus. Resultados: 52 pacientes fueron estudiados (23 mujeres y 29 hombres. 60% tenían 61 y más años. Solo tres de los 52 pacientes tenían medición de HbA1c, además en 33 pacientes (63.5%) no se conocía el tiempo de evolución de la diabetes. El 25% de los pacientes reingresó, de éstos, el 61.5% fue por reinfarto. Las personas tratadas con hipoglicemiantes orales y con insulina tuvieron mayor proporción de reingreso (34.7% y 30.0%, respectivamente) con respecto a los otros tratamientos. Conclusión: teniendo en cuenta los resultados encontrados, podemos inferir que la falta de control de la diabetes, sumadaa la edad del paciente, hace que esta enfermedad sea más deletérea, y que se requiere mejor seguimiento clínico y control terapéutico de la diabetes para prevenir las complicaciones como síndromes coronarios agudos.

Objective: to describe the clinical and epidemiological characteristics of patients with Acute Myocardial Infarction who have a history of Diabetes Mellitus. Methods: observational, descriptive and retrospective study in which were read 347 medical histories from patients aged 18 or older with Acute Myocardial Infarction and comfirmed antecedent of Diabetes Mellitus. Results: 52 patients were studied (23 female and 29 male). 60% were aged 61 or older. Only 3 of the 52 patients had HbA1cmeasurement, additionally, in 33 patients (63.5%) the time of evolution of diabetes could not be ascertained. 25% of the patients were readmitted, of these, 61.5% were readmitted for reinfarction. The patients treated with oral hypoglycemic agents andinsulin had greater proportion of readmission (34.7% y 30.0%, respectively) with respect to the others therapies. Conclusion: taking into account the results we found, we can conclude that poor Diabetes Mellitus control as well as the age of patients makes this disease more devastating, requiring better clinical follow-up and therapeutic control for diabetes in orderto prevent complications such as acute coronary syndrome.

Los estudiantes universitarios Javerianos y su respuesta al sentido de la vida / University students of the Javeriana and the their response to the meaning of life

El objetivo de este estudio fue identificar qué aspectos influyen, de manera significativa, en el sentido de vida en estudiantes, entre 16 y 34 años de edad, pertenecientes a la Carrera de Psicología de la Pontificia Universidad Javeriana de Cali. Para la recolección de la información se utilizó la escala existencial de A. Langle y C. Orgler, un instrumento técnico para el abordaje preventivo, diagnóstico y terapéutico del sentido de vida; el instrumento presentó 46 reactivos, divididos en cuatro sub-escalas: auto distanciamiento (AD), auto trascendencia (AT), libertad (L), responsabilidad (R). Dicho instrumento tuvo una calificación de tipo Likert. La muestra se conformó con un total de 277 estudiantes, distribuidos en 60 hombres y 217 mujeres, todos pertenecientes a la Carrera de Psicología, desde primero a décimo semestre. Los resultados muestran que los puntajes obtenidos se ubicaron por debajo de la media para todas las variables (edad, género y semestre) con un puntaje de 177.83 para la escala total, lo que indica que el nivel de sentido de vida de los estudiantes es bajo, sin diferencias significativas en ninguna de las variables con relación al sentido de vida.

The purpose of this study was to identify the aspects which have a significant influence on the meaning of life for psychology students between 16 and 34 years old at the Pontificia Universidad Javeriana, Cali. The instrument used to gather the information was the A. Langle and C. Orgler existential test, a technical instrument consisting of 46 items, divided into four sub groups: self-distancing, self-transcendence, freedom, and responsibility. The sample was made up of 277 students, 60 men and 217 women, ranging from first to tenth semester. The results show that the scores obtained were below average for all the variables (age, gender, and semester) with a total score of 177.83 for the total scale, which means that the meaning of life is placed at a low level, without significant differences for any of the variables relating to the meaning of life.

O objetivo deste estudo foi identificar que aspectos influem de maneira significativa no sentido de vida em estudantes, entre 16 e 34 anos de idade, pertencentes à Carreira de Psicologia da Pontifícia Universidade Javeriana de Cali. Para a colheita da informação se utilizou a escala existencial de. Langle e R. Orgler, um instrumento técnico para a abordagem preventivo, diagnóstico e terapêutico do sentido de vida; o instrumento apresentou 46 reativos, divididos em quatro sub-escalas: Auto Distanciamento (AD), Auto Transcendência (AT), Liberdade (L), Responsabilidade (R). Dito instrumento teve uma qualificação de tipo Likert. A mostra se conformou com um total de 277 estudantes, distribuídos em 60 homens e 217 mulheres, todos pertencentes à Carreira de Psicologia desde primeiro a décimo semestre. Os resultados mostram que os puntajes obtidos ficaram embaixo da meia para todos os fatores (idade, gênero e semestre) com um puntaje de 177.83 para a escala total, o que indica que o nível de sentido de vida dos estudantes se encontra em um nível baixo, sem diferenças significativas em nenhum dos fatores com relação ao sentido de vida.