Grouping of body areas affected in traffic accidents. A cohort study.

BACKGROUND: Traffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population. METHODS: Secondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24 h after admission. A cluster analysis was performed, using Ward's method and the linfinity similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim. RESULTS: Among 2445 patients with traffic accidents, 34% (n = 836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n = 201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n = 34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas. CONCLUSIONS: Exploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources.

Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population.

BACKGROUND: Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting. MATERIALS AND METHODS: Subjects older than 15 years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24 h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics. RESULTS: Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n = 3442) were male, the mean age was 36 years (SD = 16), and the most common trauma mechanism was blunt type (80.1%; n = 3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR = 10-21), 17 (IQR = 11-27), 4.21 (IQR = 2.95-5.05) and 7.84 (IQR = 6.90-7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration. CONCLUSION: Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma.

Caso inusual de difteria cutánea con compromiso mucoso y síndrome del vértex orbitario / Unusual clinical presentation of cutaneous diphteria with mucosal involvement and orbital Vertex syndrome

La difteria es una enfermedad prevenible por vacunas. En la actualidad existe un brote en nuestro país que se inició en abril de 2016. Desde entonces se han descrito casos en diferentes sitios del país predominantemente de la forma faríngea. La difteria cutánea no ha sido reportada en este brote. A nivel mundial el compromiso simultáneo en piel y mucosas, no ha sido descrito. La paciente cuya enfermedad describimos aquí es un caso de difteria de presentación atípica que se inicia con expresión cutánea y evoluciona a compromiso nasal, ocular y faríngeo con complicaciones severas en la órbita ocular expresadas como un síndrome del vértex orbitario, en una paciente con diabetes mellitus tipo 2 no controlada, que tuvo una evolución tórpida que la llevó a la muerte. Se revisa la literatura(AU)

Diphtheria is a vaccine-preventable disease. Actually, there is an outbreak in Venezuela since April 2016. Cases in different parts of the country have been described, predominantly pharyngeal. Cutaneous diphtheria has not been reported in this outbreak. The simultaneous presentation of the cutaneous form with mucosal involvement has not been described in the revised literature. We present a case of diphtheria with atypical presentation that begins with cutaneous expression and evolves to nasal, ocular and pharyngeal compromise with severe complications of the orbit, expressed in an orbital vertex syndrome in a patient with type 2 diabetes mellitus, who had a torpid evolution that led her to death. The literature is reviewed(AU)

Trauma severity indices / Trauma severity scores

Introduction: Throughout the years, several methods have been developed to help determine injury severity and obtain accurate prognoses in trauma patients. Trauma scores that have been used for more than 40 years are extremely useful in clinical practice as well as in research. Objective: To conduct a review of the most relevant literature on trauma and to make a description of each of the scoring tools, focusing on their limitations and their application in clinical trials. Materials and methods: Narrative review conducted in different databases such as PubMed, ScienceDirect and OVID. A manual search was also conducted of articles on the subject in both English and Spanish. Results: The review articles provided an adequate description of each of the scores, the way they are calculated, the main limitations in their application, and the most relevant findings in the literature. Conclusion: There is a wide range of severity scores used in trauma patients for anticipating clinically significant outcomes with varying degrees of accuracy. Creating and validating a single, universally valid score is a huge challenge; consequently, the selection of the scoring tool is based, to a large extent, on experience, the context and the available evidence.

Introducción: a lo largo de la historia se han creado varios métodos para evaluar la gravedad de las lesiones y brindar un pronóstico exacto en pacientes con trauma. Los puntajes en trauma que se han utilizado por más de 40 años son una herramienta de gran utilidad tanto para el contexto clínico como investigativo. Objetivo: elaborar una revisión de la literatura más relevante sobre los puntajes en trauma y hacer una descripción de cada una de estas herramientas, haciendo énfasis en sus limitaciones y en la aplicación en estudios clínicos. Materiales y Métodos: revisión narrativa, se consultaron diferentes bases de datos como PubMed, ScienceDirect y OVID; además, se hizo búsqueda manual de artículos en inglés y en español sobre el tema. Resultados: los artículos revisados permitieron hacer una descripción adecuada de cada uno de los puntajes, de la forma en que se calculan, sus principales limitaciones al momento de aplicarlos y los hallazgos más notables en la literatura. Conclusión: existe una gran variedad de puntajes de gravedad para pacientes con trauma que permiten anticipar con diferente exactitud los desenlaces clínicamente significativos. La creación y validación de un único puntaje universalmente válido es todo un reto; por ello la selección de esta herramienta está basada en gran parte en la experiencia, el contexto y la evidencia disponible.

Portal hypertensive biliopathy: A single center experience and literature review.

Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging modalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.

Validación de la escala de envolvimiento emocional y criticismo familiar (FEICS) en la población clínica psiquiátrica colombiana / Validation of the Family Emotional Involvement and Criticism Scale (FEICS) in Colombian Psychiatric Clinical Population

Objetivo: validar la escala de envolvimiento emocional y crítica familiar (FEICS) en la población clínica psiquiátrica colombiana. Métodos: se tradujo la escala y luego se hizo el mismo proceso en sentido inverso. Se evaluaron: validez de apariencia por un grupo de expertos, validez de contenido y conceptos mediante análisis factorial de componentes principales, validez concurrente mediante comparación con "monólogo de cinco minutos" y subescala de cohesión de la Escala de Evaluación de Adaptabilidad y Cohesión Familiar (FACES-III), consistencia interna y reproducibilidad test-retest. Resultados: en el análisis factorial se encontraron cuatro dominios: censura, envolvimiento, intrusión y apoyo, que explicaron el 57,4 de la varianza. La consistencia interna de la subescala de crítica fue buena con una alfa de Crombach de 0,76 y la subescala de envolvimiento fue baja con un alfa de Crombach de 0,54. La reproducibilidad test-retest de la subescala de criticismo fue excelente (CCI = 0,92) y de la subescala de envolvimiento, buena (CCI = 0,62). Hubo una correlación significativa entre la subescala de crítica y el número de comentarios críticos del "monólogo de cinco minutos" (r = 0,31, p = 0,0001). Conclusiones: la FEICS fue de fácil aplicación y mostró cuatro dominios, a diferencia de los dos de la escala original. La subescala de crítica tiene gran consistencia interna, reproducibilidad test-retest y validez de concepto, lo cual la hace útil para la práctica clínica y de investigación. A pesar de que la subescala de envolvimiento se correlacionó con la FACESIII y su reproducibilidad test-retest fue buena, su escasa consistencia interna hace pensar en la necesidad de estudiar con mayor profundidad factores culturales asociados con el envolvimiento para posiblemente modificar los ítems de esta subescala...