Trends in Scientific Publications for the French West Indies and the Dominican Republic from 1990 through 2019: Infectious Diseases.

OBJECTIVE: The French West Indies (FWI) and the Dominican Republic (DR) are also, by virtue of their geographical positions, exposed to infectious diseases. The objective of this study was to describe trends in scientific publication for the FWI and the DR using bibliometric analysis, to describe existing international collaborations for each site, and to identify directions for potential collaboration between the 2 sites. METHODOLOGY: Using data (publications from 1990-2019) from the Web of Science and PubMed databases, a bibliometric analysis was performed. Three bibliometric indicators were used: quantitative, performance, and organization-specific. RESULTS: There were 3599 articles published in the indicated span of time, with at least 1 author affiliated with either the FWI (N = 2552) or the DR (N = 1047). Journals ranked in the first quartile, which represent the highest quality journals in each Journal Citation Record category, were the most strongly represented, (38% for the FWI and 50.32% for the DR). In terms of the FWI publications, authors from mainland France were the primary collaborators (1754, 35%); for publications from the DR, the US provided the largest number of collaborators (898; 43%). The infectious disease category predominated, with 2 clusters emerging: arbovirus infections (FWI) and HIV infection (DR). CONCLUSION: This study is one of the first to perform a bibliometric analysis of the 30-year scientific output of the FWI and the DR. Both sites published articles about infectious diseases, indicating that this might be a strong area for future collaborations.

Valoración de la Escala News (National Early Warning Score) como predictor de sepsis en pacientes con síndrome febril. Servicio Medicina Interna, Hospital Salvador Bienvenido Gautier, agosto-diciembre 2019 / News (National Early Warning Score) scale assessment as sepsis predictor in patients with febril syndrome. Internal Medicine Emergency Department, Salvador Bienvenido Gautier Hospital, August-December 2019

Introducción: la utilización de la escala NEWS podría construir una herramienta en el diagnóstico, pronóstico y estratificación precoz ante la sospecha de sepsis. El propósito de esta investigación fue determinar la eficacia de la escala NEWS como predictor de sepsis en pacientes ingresados por síndrome febril en el Hospital Salvador Bienvenido Gautier, en el período de octubre-diciembre 2019. Material y método: se realizó un estudio descriptivo, prospectivo y de corte transversal donde la técnica utilizada para la recolección de la información fue la evaluación directa de los 43 pacientes admitidos aplicando la escala NEWS y revisión de expedientes clínicos. Resultados: se determinó que el punto de corte ≥6 en la escala NEWS obtuvo valores de sensibilidad (91 %), especificidad (70 %), índice de Youden de 0.61, valor predictivo positivo de 78 %, valor predictivo negativo de 88 %, razón de verosimilitud positiva de 3 y negativa de 0.1. La aplicación de la escala NEWS en el sexo masculino presentó una sensibilidad de 92.9 % y especificidad de 87.5 %. En los grupos de 18-30 y 71-80 años, esta escala presentó una sensibilidad y especificidad de 100 %. Los pacientes clasificados como riesgo bajo, moderado y alto fueron diagnosticados con sepsis el 16.67 %, 63.64 % y un 70 %, respectivamente. Conclusiones: una puntuación mayor o igual a 6 en la escala NEWS se presenta como un predictor estadísticamente significativo que ayudaría en el diagnóstico temprano de sepsis, siendo más sensible que especifica. Fue mejor predictor en el sexo masculino y en los grupos etarios de 18-30 y 71-80 años

Introduction: The use of the NEWS could build a tool in the diagnosis, prognosis and early stratification in case of suspected sepsis. The purpose of this research was to determine the efficacy of the NEWS as a predictor of sepsis in patients admitted for febrile syndrome at the Salvador Bienvenido Gautier Hospital, October-December 2019. Materials and methods: A descriptive, prospective and crosssectional study was conducted where the technique used for the collection of the information was the direct evaluation of the 43 admitted patients applying the NEWS and the review of clinical records. Results: It was determined that the cutoff point ≥6 on the NEWS obtained sensitivity value (91%), specificity (70%), Youden index of 0.61, positive predictive value of 78%, negative predictive value of 88%, ratio of positive likelihood of 3 and negative of 0.1. The application of the NEWS scale in males presented a sensitivity of 92.9% and specificity of 87.5%. In the groups of 18-30 and 71-80 years, this scale presented a sensitivity and specificity of 100%. Patients classified as low, moderate and high risk were diagnosed with sepsis 16.67%, 63.64% and 70% respectively. Conclusions: A score greater than or equal to 6 on the NEWS is presented as a statistically significant predictor that would help in the early diagnosis of sepsis being more sensitive than specific. It was a better predictor in the male sex and in the age groups of 18-30 and 71-80 years

Clinical Manifestations and Outcomes in Disease-Modifying Antirheumatic Drug-Naive Adult Patients with Chronic Chikungunya Arthritis.

Most studies on chronic chikungunya virus (CHIKV) arthritis include patients treated with disease-modifying antirheumatic drugs (DMARDs), likely altering the expression of clinical manifestations and outcome. Therefore, we sought to evaluate the clinical features and correlates in DMARD-naive patients with chronic CHIKV arthritis. We conducted a case-control study in adult patients with serologically confirmed CHIKV infection in Puerto Rico. Demographic features, clinical manifestations, comorbidities, disease activity (per Clinical Disease Activity Index [CDAI]), functional status (per Health Assessment Questionnaire Disability Index [HAQ-DI]), and pharmacologic treatment were ascertained. Patients with and without chronic CHIKV arthritis were compared. Furthermore, a sub-analysis was performed among patients with chronic CHIKV who presented with mild disease activity versus moderate-to-high disease activity at study visit. In total, 61 patients were studied; 33 patients had chronic arthritis and 28 had resolved arthritis. Patients with chronic arthritis had significantly more diabetes mellitus, chronic back pain, and fever, tiredness, and myalgias on the acute phase. The mean (SD) HAQ score was 0.95 (0.56), and 57.6% had moderate-to-high disease activity. Patients with moderate-to-high disease activity had higher scores in overall HAQ-DI and HAQ-DI categories (dressing and grooming, arising, hygiene, reaching, and activities) than in those with mild activity. In conclusion, in this group of DMARD-naive patients with chronic CHIKV arthritis, nearly 58% had moderate-to-high disease activity and had substantial functional disability. Diabetes mellitus, chronic back pain, and some manifestations on acute infection were associated with chronic CHIKV arthritis.

Análisis de 1.000 fetos muertos / Analysis of one thousand stillborn

Se analizan 1.000 natimuertos en la Maternidad Concepción Palacios entre julio de 1985 y diciembre de 1986. Fue posible establecer la causa de muerte en el 66,6% de los casos, siendo principales responsables de las mismas: hipertensión inducida por el embarazo, sangrados y malformaciones congénitas. Las complicaciones del parto se presentaron en 26 pacientes, de las cuales 14 correspondian a dehiscencias de cicatrices uterinas y 7 a roturas uterinas. Hubo complicaciones maternas graves como la coagulación intravascular diseminada en 13 casos y dos muertes maternas. Se hacen recomendaciones sobre la conveniencia de practicar autopsia a los natimuertos, tomar muentras de sangre o piel fetal para estudio cromosomico, así como estudiar histológicamente la plancenta y el cordon umbilical. La muerte fetal es definida como aquella que se produce después de las 20 semanas de gestación, o cuando el peso del feto es superior a los 500 gramos. En los ultimos 30 años la mortalidad fetal ha disminuido gracias al avance de la medicina y el desarrollo de los cuidados prenatales. Pero actualmente aún subsisten situaciones no controlables o identificables que causan el deceso del feto. La muerte intrauterina es un hecho lamentable con repercusiones para los padres y para el médico tratante, desencadenando una serie de interrogantes que éste último debe contestar; esta situación, vivida a diario en nuestro ejercicio hospitalario, nos llevó a realizar una nueva revisión de la materia