¿Cómo detectar a los pacientes mayores no institucionalizados en riesgo de malnutrición durante su hospitalización? Comparación de 8 herramientas de cribado de malnutrición o de riesgo nutricional / How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk

Antecedentes: La prevalencia de malnutrición es elevada entre la población mayor. El ingreso hospitalario es una ventana de oportunidad para su detección. Objetivo: Valorar la concordancia de distintas escalas nutricionales en pacientes hospitalizados.Método: Estudio prospectivo en pacientes mayores de 65años no institucionalizados ingresados en un servicio de Medicina Interna. Se compararon 5 encuestas de cribado de malnutrición (MNA, MST, MUST, NRS-2000 y CONUT) y 3 encuestas de cribado de riesgo nutricional (SCREEN3, 8 y 14). Como patrón de referencia se utilizó la definición de malnutrición de la Iniciativa Global para el Liderazgo en Malnutrición (GLIM). Resultados: Se incluyeron 85 pacientes (37% mujeres, mediana de edad 83años). El 48% (IC95%: 38-59%) de los pacientes fueron clasificados como malnutridos según criterios GLIM. La escala SCREEN3 fue la más sensible (93%; IC95%: 87-98) y MUST la más específica (91%; IC95%: 85-99). La escala más eficaz para excluir la sospecha de malnutrición fue SCREEN3 (LR− 0,17; IC95%: 0,05-0,53) y la mejor para confirmarla fue MST (LR+ 7,08; IC95%: 3,06-16,39). La concordancia entre las distintas escalas fue baja o muy baja, con índices kappa entre 0,082 y 0,465.Conclusiones: Se precisa un abordaje integral para detectar la malnutrición en adultos mayores ingresados. Las escalas más sensibles son más útiles en el cribado inicial. Las herramientas de riesgo nutricional podrían ser eficaces en esta etapa. En un segundo paso se debe confirmar la malnutrición de acuerdo con criterios establecidos como los de la GLIM.(AU)

Background: The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. Objective: To assess the concordance of different nutritional scales in hospitalized patients. Methods: Prospective study in non-institutionalized patients over 65years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN3, 8 and 14) were compared. As gold standard we use the Global Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. Results: Eighty-five patients (37% female, median age 83years) were included. Forty-eight percent (95%CI: 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN3 scale was the most sensitive (93%; 95%CI: 87-98) and MUST the most specific (91%; 95%CI: 85-99). The most effective scale for excluding suspected malnutrition was SCREEN3 (LR− 0.17; 95%CI: 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95%CI: 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. Conclusions: A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.(AU)

Performance of adenosine deaminase in synovial fluid for the diagnosis of tuberculous arthritis: A systematic review and meta-analysis.

OBJECTIVES: Adenosine deaminase (ADA) activity has shown good performance in diagnosing pleural, peritoneal, and meningeal tuberculosis. This meta-analysis aimed to evaluate the performance of measuring ADA activity in synovial fluid for the early diagnosis of joint tuberculosis. METHODS: We searched published information in MEDLINE, Embase, Cochrane Library, Web of Science, and MedRxiv databases, as well as unpublished information in the American College of Rheumatology and European League Against Rheumatism for conference abstracts (2012-2021). We also scanned the reference lists of articles. Two reviewers independently applied the criteria for selection, assessed quality, and extracted data (PROSPERO number CRD42021284472). RESULTS: Seven independent studies (N=305 subjects) that compared ADA activity in synovial fluid with a composite reference diagnostic method for tuberculosis were included. Overall, the risk of bias was judged low. Studies were classified as high quality (n=3; 148 subjects) and low quality (n=4; 157 subjects). Pooled sensitivity and specificity of ADA activity was 94% (95% confidence interval [CI], 0.89-98; I2=23%) and 88% (95% CI, 83-92; I2=83%), respectively. The random-effects model for pooled diagnostic Odds ratio was 67.1 (95%CI, 20.3-222.2; I2=30%). The receiver operating characteristic curve area was 0.96 (95% CI, 0.92-0.99). Meta-regression did not identify the quality of the study, country of publication, or the type of assay as a source of heterogeneity. CONCLUSIONS: Measuring ADA activity in synovial fluid demonstrates good performance for the early diagnosis of joint tuberculosis.

Performance of adenosine deaminase in synovial fluid for the diagnosis of tuberculous arthritis: A systematic review and meta-analysis / Rendimiento de la adenosina desaminasa en el líquido sinovial para el diagnóstico de la artritis tuberculosa: una revisión sistemática y metaanálisis

Objectives: Adenosine deaminase (ADA) activity has shown good performance in diagnosing pleural, peritoneal, and meningeal tuberculosis. This meta-analysis aimed to evaluate the performance of measuring ADA activity in synovial fluid for the early diagnosis of joint tuberculosis. Methods: We searched published information in MEDLINE, Embase, Cochrane Library, Web of Science, and MedRxiv databases, as well as unpublished information in the American College of Rheumatology and European League Against Rheumatism for conference abstracts (2012–2021). We also scanned the reference lists of articles. Two reviewers independently applied the criteria for selection, assessed quality, and extracted data (PROSPERO number CRD42021284472). Results: Seven independent studies (N=305 subjects) that compared ADA activity in synovial fluid with a composite reference diagnostic method for tuberculosis were included. Overall, the risk of bias was judged low. Studies were classified as high quality (n=3; 148 subjects) and low quality (n=4; 157 subjects). Pooled sensitivity and specificity of ADA activity was 94% (95% confidence interval [CI], 0.89–98; I2=23%) and 88% (95% CI, 83–92; I2=83%), respectively. The random-effects model for pooled diagnostic Odds ratio was 67.1 (95%CI, 20.3–222.2; I2=30%). The receiver operating characteristic curve area was 0.96 (95% CI, 0.92–0.99). Meta-regression did not identify the quality of the study, country of publication, or the type of assay as a source of heterogeneity. Conclusions: Measuring ADA activity in synovial fluid demonstrates good performance for the early diagnosis of joint tuberculosis.(AU)

Objetivos: La actividad de la adenosina desaminasa (ADA) ha mostrado un buen desempeño en el diagnóstico de la tuberculosis pleural, peritoneal y meníngea. Este metaanálisis tuvo como objetivo evaluar el rendimiento de la medición de la actividad de la ADA en el líquido sinovial para el diagnóstico precoz de la tuberculosis articular. Métodos: Se realizaron búsquedas de resúmenes de congresos en la información publicada en las bases de datos MEDLINE, Embase, Cochrane Library, Web of Science y MedRxiv, así como en información no publicada en el American College of Rheumatology y la European League Against Rheumatism (2012-2021). También se escanearon las listas de referencias de los artículos. Dos revisores aplicaron de forma independiente los criterios de selección, evaluaron la calidad y extrajeron los datos (número PROSPERO CRD42021284472). Resultados: Se incluyeron siete estudios independientes (n=305 sujetos) que compararon la actividad de la ADA en el líquido sinovial con un método diagnóstico compuesto de referencia para la tuberculosis. En general, el riesgo de sesgo se consideró bajo. Los estudios se clasificaron como de alta calidad (n=3; 148 sujetos) y de baja calidad (n=4; 157 sujetos). La sensibilidad y la especificidad agrupadas de la actividad de la ADA fueron del 94% (intervalo de confianza [IC] del 95%: 0,89-98; I2=23%) y del 88% (IC95%: 83-92; I2=83%), respectivamente. El modelo de efectos aleatorios para el odds ratio diagnóstico agrupado fue de 67,1 (IC95%: 20,3-222,2; I2=30%). El área de la curva característica de operación del receptor fue de 0,96 (IC95%: 0,92-0,99). La metarregresión no identificó la calidad del estudio, el país de publicación o el tipo de ensayo como fuente de heterogeneidad.Conclusiones: La medición de la actividad de ADA en el líquido sinovial demuestra un buen rendimiento para el diagnóstico precoz de la tuberculosis articular.(AU)

How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk.

BACKGROUND: The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. OBJECTIVE: To assess the concordance of different nutritional scales in hospitalized patients. METHODS: Prospective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. RESULTS: Eighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87-98) and MUST the most specific (91%; CI 85-99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR- 0.17; 95% CI 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. CONCLUSIONS: A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.

Características operativas de la ecografía en el diagnóstico del Síndrome de Sjögren / Operational characteristics of ultrasound in the diagnosis of Sjögren's syndrome

Antecedentes y objetivo: Determinar las características operativas de la ecografía de glándula salival (EGS) en el diagnóstico del síndrome de Sjögren (SS) en una población de pacientes colombianos con síntomas secos. Materiales y métodos: Estudio de pruebas diagnósticas en pacientes con síntomas secos que asistieron a la consulta de reumatología (2018-2020). Se obtuvieron datos sociodemográficos y clínicos a través de una encuesta, pruebas paraclínicas, oftalmológicas, biopsia de glándula salival menor, flujo salival no estimulado y EGS (puntuación 0-6 basada en De Vita). Se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN) (Stata 15®). Se desarrolló la curva de características operativas del receptor (COR). Resultados: Se incluyó a 102 pacientes (34 con SS y 68 sin SS), edad media ± desviación estándar de 55,69 ± 11,93 años, 94% mujeres. La ecografía positiva (puntuación de 2 o más) fue más frecuente en el grupo de SS, (70,6% vs. 22,1%, p < 0,0001). La sensibilidad fue igual para el grado 2 y 3 (70,59%), con una especificidad mayor (89,71%) para el grado 3 (VPP 77,42% VPN 85,92). La curva COR a partir de la sumatoria de las glándulas por medio de ecografía, fue mejor que las de las glándulas independientes. La curva COR de la ecografía presentó una mayor área bajo la curva (0,72 [0,61-0,82]) que la del análisis histológico (puntuación por focos) (0,68 [0,59-0,78]), p = 0,0252. Conclusión: La EGS es un método útil y confiable para la clasificación del SS. Se podría plantear su uso futuro dentro de los criterios clasificatorios del SS.(AU)

Background and objective: To determine the operational characteristics of salivary gland ultrasound (SGU) in the diagnosis of Sjögren's syndrome (SS) in a population of colombian patients with dry symptoms. Materials and methods: Study of diagnostic tests in patients with dry symptoms who consecutively attended the rheumatology consultation (2018-2020). Sociodemographic and clinical data were obtained through a survey, paraclinical and ophthalmological tests, minor salivary gland biopsy, unstimulated salivary flow and SGU (score 0-6 based on De Vita) were done. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (Stata 15®) were calculated. The receiver operating characteristics (ROC) curve was developed. Results: 102 patients were included (34 SS and 68 non-SS), mean age 55.69 (± 11.93) years, 94% women. Positive ultrasound (score of 2 or more) was more frequent in the SS group, (70.6% vs. 22.1%, P<.0001). The sensitivity was the same for grade 2 and 3 (70.59%), with a higher specificity (89.71%) for grade 3 (PPV 77.42% NPV 85.92). The ROC curve from the sum of the glands by means of ultrasound was better than those of the independent glands. The ROC curve of the ultrasound presented a greater area under the curve (0.72 [0.61-0.82]) than that of the histological analysis (focus score) (0.68 [0.59-0.78]), P=.0252. Conclusion: Salivary gland ultrasound is a useful and reliable method for the classification of SS. Its use could be considered in the future within the SS classification criteria.

Operational characteristics of ultrasound in the diagnosis of Sjögren's syndrome.

BACKGROUND AND OBJECTIVE: To determine the operational characteristics of salivary gland ultrasound (SGU) in the diagnosis of Sjögren's syndrome (SS) in a population of colombian patients with dry symptoms. MATERIALS AND METHODS: Study of diagnostic tests in patients with dry symptoms who consecutively attended the rheumatology consultation (2018-2020). Sociodemographic and clinical data were obtained through a survey, paraclinical and ophthalmological tests, minor salivary gland biopsy, unstimulated salivary flow and SGU (score 0-6 based on De Vita) were done. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (Stata 15®) were calculated. The receiver operating characteristics (ROC) curve was developed. RESULTS: 102 patients were included (34 SS and 68 non-SS), mean age 55.69 (±11.93) years, 94% women. Positive ultrasound (score of 2 or more) was more frequent in the SS group, (70.6% vs. 22.1%, P<0.0001). The sensitivity was the same for grade 2 and 3 (70.59%), with a higher specificity (89.71%) for grade 3 (PPV 77.42% NPV 85.92). The ROC curve from the sum of the glands by means of ultrasound was better than those of the independent glands. The ROC curve of the ultrasound presented a greater area under the curve (0.72 [0.61-0.82]) than that of the histological analysis (focus score) (0.68 [0.59-0.78]), P=0.0252. CONCLUSION: Salivary gland ultrasound is a useful and reliable method for the classification of SS. Its use could be considered in the future within the SS classification criteria.

Instrumentos para la evaluación del riesgo de lesiones por presión en adultos en estado crítico: scoping review / Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review / Instrumentos para a avaliação do risco de lesões por pressão para adultos em situação crítica: scoping review*

Objetivo: mapear los instrumentos para la evaluación del riesgo de lesiones por presión en adultos en situación crítica en una unidad de terapia intensiva; identificar los indicadores de desempeño de los instrumentos y la apreciación de los usuarios con respecto al uso/limitaciones de los instrumentos. Método: scoping review. Para redactar el estudio se utilizó la extensión Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. La investigación se realizó mediante la herramienta de búsqueda EBSCOhost en 8 bases de datos, resultando 1846 estudios, de los cuales 22 conforman la muestra. Resultados: se identificaron dos grandes grupos de instrumentos: los generalistas [Braden, Braden (ALB), Emina, Norton-MI, RAPS y Waterlow]; y los específicos (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi y Sanada y el índice COMHON). En cuanto al valor predictivo, EVARUCI y CALCULATE mostraron los mejores resultados de indicadores de desempeño. En cuanto a las apreciaciones/limitaciones señaladas por los usuarios, destaca la escala CALCULATE, seguida de la EVARUCI y la RAPS-ICU, aunque aún necesitan ajustes futuros. Conclusión: el mapeo mostró que las evidencias son suficientes para indicar uno o más instrumentos para la evaluación del riesgo de lesiones por presión en adultos críticos en una unidad de cuidados intensivos.

Objective: to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments' use/limitations. Method: a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample. Results: we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments. Conclusion: the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units.

Objetivo: mapear os instrumentos para avaliação do risco de lesões por pressão nos adultos em situação crítica em unidade de cuidados intensivos; identificar os indicadores de desempenho dos instrumentos e a apreciação dos utilizadores quanto ao uso/às limitações dos instrumentos. Método: scoping review. O Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews foi utilizado para a redação do estudo. A pesquisa foi realizada na ferramenta de busca EBSCOhost em oito bases de dados, resultando em 1846 estudos, dos quais 22 compõem a amostra. Resultados: identificaram-se dois grandes grupos de instrumentos: os genéricos [Braden, Braden (ALB), Emina, Norton-MI, RAPS e Waterlow]; e os específicos (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi e Sanada e o índice de COMHON). Quanto ao valor preditivo, a EVARUCI e a CALCULATE apresentaram os melhores resultados de indicadores de desempenho. Em relação à apreciação/às limitações apontadas pelos utilizadores, destacam-se a escala CALCULATE, seguindo-se da EVARUCI e da RAPS-ICU, embora ainda necessitem de ajustes futuros. Conclusão: o mapeamento mostrou que as evidências são suficientes para indicar um ou mais instrumentos para avaliação do risco de lesões por pressão nos adultos em situação crítica em unidade de cuidados intensivos.

Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES: To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS: Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS: 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE: CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.

Procalcitonin and C-reactive protein: markers in the early diagnosis of anastomotic leak.

OBJECTIVE: To determine the efficacy of serum procalcitonin (PCT) and C-reactive protein (CRP) in the early diagnosis of anastomotic leak (AL) in patients undergoing colorectal surgery. METHOD: Diagnostic test in a tertiary care hospital. Patients who did not have preoperative measurements of PCT and CRP were excluded. Those with postoperative infection not related to AL were eliminated. The diagnostic efficacy measures were sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios, and area under the receiver operating characteristic curve (AUROC). RESULTS: Thirty-nine patients were analyzed; six had AL (15.4%). PCT and CRP increased on the second postoperative day, only in patients with AL. The cut-off points at the second postoperative day were 1.55 ng/mL for PCT and 11.25 mg/L for CRP. The most efficacious test was PCR at second postoperative day (AUROC: 1.00; Sn: 100%; Sp: 96.7%; PPV: 85.7%; NPV: 100%; LR+: 33.0). CONCLUSIONS: CRP at second postoperative day was the most effective test in the early diagnosis of AL in patients undergoing colorectal surgery, with a cut-off point lower than that reported in the international literature.

OBJETIVO: Determinar la eficacia de la procalcitonina (PCT) y la proteína C reactiva (PCR) séricas en el diagnóstico de fuga anastomótica (FA) en los pacientes sometidos a cirugía colorrectal. MÉTODO: Prueba diagnóstica en un hospital de tercer nivel. Se excluyeron los pacientes que no tuvieron mediciones preoperatorias de PCT y PCR. Se eliminaron los que cursaron con infección posoperatoria no relacionada con FA. Las medidas de eficacia diagnóstica fueron sensibilidad (S), especificidad (E), valores predictivos positivo (VPP) y negativo (VPN), razones de verosimilitud positiva (RV+) y negativa (RV−), y área bajo la curva característica operativa del receptor (AUROC). RESULTADOS: Se analizaron 39 pacientes, de los cuales 6 (15.4%) tuvieron FA. La PCT y la PCR aumentaron al segundo día posoperatorio solo en los pacientes con FA. Los puntos de corte al día 2 fueron 1.55 ng/ml para PCT y 11.25 mg/l para PCR. La prueba más eficaz fue la PCR al día 2 (AUROC: 1.00; S: 100%; E: 96.7%; VPP: 85.7%; VPN: 100%; RV+: 33.0). CONCLUSIONES: La PCR en el segundo día posoperatorio fue la prueba más eficaz en el diagnóstico temprano de FA en los pacientes sometidos a cirugía colorrectal, con un punto de corte inferior a lo reportado en la literatura internacional.

TC-4D como prueba de localización preoperatoria de segunda línea en la evaluación del hiperparatiroidismo primario / 4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism

Introducción: La tomografía computarizada en cuatro dimensiones (TC-4D) ofrece buena sensibilidad para localizar la glándula patológica responsable del hiperparatiroidismo primario. El objetivo fue evaluar su rendimiento como estudio de segunda línea tras ausencia de localización o resultado no concordante de los estudios habituales. Material y métodos: Estudio observacional retrospectivo que incluyó todos los pacientes intervenidos por hiperparatiroidismo primario con TC-4D como estudio preoperatorio, del 1 de octubre de 2016 al 1 de octubre de 2021, en un centro hospitalario de tercer nivel. Se compararon los resultados de la TC-4D, la ecografía y las exploraciones de medicina nuclear (gammagrafía, SPECT y SPECT-TC) con el gold standard de la exploración quirúrgica y el resultado anatomopatológico, analizando los porcentajes de lateralización correcta y localización aproximada de la glándula patológica. Resultados: El análisis incluyó 64 pacientes, con una curación del 93,8% (60/64). La TC-4D mostró una lateralización correcta del 57,8% (37/64) y reveló la localización aproximada de la glándula en el 48,4% (31/64). La ecografía tuvo unos porcentajes del 31,1% (19/61) y del 18% (11/61) para la lateralización correcta y la localización aproximada, respectivamente, vs. un 34,9% (22/63) y un 28,6% (18/63) de los estudios de medicina nuclear y un 32,7% (16/49) y un 24,5% (12/49) de la SPECT-TC. Estas diferencias fueron estadísticamente significativas. Conclusiones: La TC-4D ofrece un rendimiento aceptable para localizar las lesiones responsables del hiperparatiroidismo primario, por lo que debería considerarse su uso ante la ausencia de localización en los estudios habituales. (AU)

Introduction: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. Material and methods: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and nuclear medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. Results: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4D-CT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in nuclear medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. Conclusion: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies. (AU)

Escala predictiva de los resultados adversos en la hemorragia digestiva alta no varicosa

Introducción: Existen varios sistemas de puntuación para predecir los resultados adversos en los pacientes con hemorragia digestiva alta no varicosa, pero no se han validado lo suficiente y cada uno pertenece a distintas poblaciones fuentes. Objetivo: Demostrar la utilidad de una escala propuesta para predecir las probabilidades de resangrado, de mortalidad y de necesidad de cirugía en los pacientes con hemorragia digestiva alta no varicosa. Métodos: Se realizó un estudio retrospectivo de una prueba diagnóstica en el hospital de Prenda, Luanda, Angola desde enero del 2021 hasta mayo del 2022. El universo estuvo formado por 93 pacientes atendidos durante ese período con el criterio de inclusión de tener el diagnóstico de hemorragia digestiva alta de origen no varicoso. Resultados: De un total de 93 pacientes se obtuvo como desenlace primario una recurrencia del sangrado de 18 pacientes para un 19,35 % del total, seguido con 12 fallecidos para un 12,90 % del total y cuatro fallecidos para un 4,40 % del total. Los valores predictivos de la escala de forma general fueron, al ser aplicada una sensibilidad de 0,91, la especificidad de un 0,92, el valor predictivo negativo de un 0,95 y el valor predictivo negativo de un 0,86. Conclusiones: La escala propuesta tiene una sensibilidad y especificidad adecuada para predecir, en los pacientes con hemorragia digestiva alta no varicosa, la probabilidad de resangrado, de mortalidad y la necesidad de cirugía.

Introduction: Several scoring systems exist to predict adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding, but they have not been sufficiently validated and each pertains to different source populations. Objective: To demonstrate the usefulness of a proposed scoring scale to predict the probability of rebleeding, mortality, and need for surgery in patients with nonvariceal upper gastrointestinal bleeding. Methods: A retrospective study of a diagnostic test was performed at the hospital of Prenda, Luanda, Angola, from January 2021 to May 2022. The study universe consisted of 93 patients attended during that period, with the inclusion criterion of having a diagnosis of upper gastrointestinal bleeding of nonvariceal origin. Results: From a total of 93 patients, the primary outcome was a recurrence of bleeding in 18 patients, accounting for 19.35% of the total; followed by 12 deaths, representing 12.90% of the total, and four deaths, accounting for 4.40% of the total. After the scale was applied, the following general predictive values were obtained: sensitivity of 0.91, specificity of 0.92, negative predictive value of 0.95 and negative predictive value of 0.86. Conclusions: The proposed scale presents adequate sensitivity and specificity for predicting the probability of fatal rebleeding and the need for surgery in patients with nonvariceal upper gastrointestinal bleeding.

Herramientas disponibles en español para la valoración clínica del delirium. Revisión sistemática / Tools available in Spanish for clinical assessment of delirium. Systematic review

Introducción: La evaluación del delirium es difícil, porque implica la alteración de diferentes funciones mentales en pacientes de cualquier edad con patologías medicoquirúrgicas graves o demencia. Por tanto, se requieren herramientas de evaluación concretas para necesidades específicas. Esta revisión sistemática sintetiza la información sobre las herramientas disponibles en español para la evaluación clínica del delirium. Materiales y métodos: Ésta es una revisión sistemática que sigue la guía PRISMA-Diagnostic Test Accuracy. Usando un algoritmo de búsqueda, dos investigadores evaluaron cinco sistemas de indexación científica y buscaron artículos adicionales y bibliografía gris. Otros dos investigadores registraron de forma estandarizada los datos de los trabajos incluidos. Se evaluó la calidad de las traducciones, adaptaciones culturales y validaciones. Resultados: Identificamos 21 trabajos sobre traducción, adaptación cultural o validación de 14 herramientas para: a) evaluación detallada, diagnóstico y cuantificación de la gravedad por parte de expertos; b) evaluación de aspectos concretos del delirium; c) cribado en adultos; d) cribado pediátrico; y e) diagnóstico y ponderación de gravedad por técnicos tratantes. El 78,6% de las traducciones y todas las adaptaciones son de buena calidad. El 52,9% de las validaciones tiene riesgo bajo de sesgo; el 41,2%, riesgo moderado; y sólo el 5,9%, riesgo alto. Conclusiones: Dado que el primer paso para tratar correctamente a los pacientes es un diagnóstico preciso y que la selección de los instrumentos adecuados es fundamental para la validez de cualquier estudio, las herramientas disponibles deben elegirse de acuerdo con las necesidades clínicas y de investigación específicas.(AU)

Introduction: Delirium assessment is difficult because it involves the alteration of different mental functions in patients of any age who have serious medical-surgical conditions or dementia. Therefore, concrete assessment tools for specific needs are required. This systematic review synthetizes the information about the tools available in Spanish for delirium clinical assessment. Materials and methods: This is a systematic review that follows the PRISMA Diagnostic Test Accuracy guideline. Using a search algorithm, two researchers assessed five scientific indexing systems and searched for additional papers and grey literature. Other two researchers recorded in a standardized way the data of the papers included. The quality of translations, cultural adaptations, and validations were assessed. Results: We identified 21 reports on translation, cultural adaptation, or validation of 14 tools for 1) detailed evaluation, diagnosis, and quantification of severity by experts, 2) assessment of concrete aspects of delirium, 3) screening in adults, 4) pediatric screening, and 5) diagnosis and weighting of severity by treating staff. 78.6% of translations and all adaptations are of good quality. 52.9% of validations have a low risk of bias, 41.2% have a moderate risk, and only 5.9% have a high risk. Conclusions: As the first step to correctly treat patients is an accurate diagnosis, and the selection of the appropriate instruments is essential for the validity of any study, the available.(AU)

4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism.

INTRODUCTION: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. MATERIAL AND METHODS: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and Nuclear Medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. RESULTS: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4DCT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in Nuclear Medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. CONCLUSION: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies.

Pap smear performance in bacterial vaginosis diagnosis / Realización de la prueba de papanicolaou en el diagnóstico de la vaginosis bacteriana / Desempenho do exame citopatológico no diagnóstico de vaginose bacteriana

ABSTRACT Objective: to assess Pap smear performance in bacterial vaginosis diagnosis in women of childbearing age. Method: a cross-sectional, retrospective study carried out in a health unit in a city in the interior of São Paulo. The study included information from 1,173 women who underwent collection of Pap smear and Gram-stained vaginal smears (reference standard test for bacterial vaginosis diagnosis) and analysis based on the Nugent score, from January 2013 to June 2020. Secondary data collected from the information and internal control systems were used. Results: the prevalence of bacterial vaginosis in the sample was 31.8%. The degree of agreement between the two diagnostic methods by the Kappa index was 0.54, considered moderate, with a value <0.001. Sensitivity was 55.2% and specificity was 94.1%, with accuracy of 81.7% and positive predictive value of 81.4% and negative of 81.8%. Conclusion: Pap smear showed agreement with the reference standard of 0.77, however, does not replace the Gram-stained vaginal smear, but can be used as an auxiliary method for bacterial vaginosis diagnosis.

RESUMEN Objetivo: evaluar el desempeño del examen citopatológico en el diagnóstico de vaginosis bacteriana en mujeres en edad fértil. Método: estudio transversal, retrospectivo, realizado en una unidad de salud de una ciudad del interior de São Paulo. El estudio incluyó información de 1173 mujeres a las que se les realizó recolección de pruebas citopatológicas y frotis vaginales teñidos con la técnica de Gram (prueba estándar de referencia para el diagnóstico de vaginosis bacteriana) y análisis con base en el puntaje de Nugent, desde enero de 2013 hasta junio de 2020. Datos secundarios recolectados de los sistemas de información y control interno. Resultados: la prevalencia de vaginosis bacteriana en la muestra fue de 31,8%. El grado de concordancia entre los dos métodos diagnósticos por el índice Kappa fue de 0,54, considerado moderado, con un valor <0,001. La Sensibilidad fue del 55,2% y la Especificidad del 94,1%, con una Precisión del 81,7% y un Valor Predictivo Positivo del 81,4% y Negativo del 81,8%. Conclusión: el examen citopatológico mostró concordancia con el patrón de referencia de 0,77, sin embargo, no sustituye al frotis vaginal teñido de Gram, pero puede utilizarse como método auxiliar para el diagnóstico de la vaginosis bacteriana.

RESUMO Objetivo: avaliar o desempenho do exame citopatológico no diagnóstico de vaginose bacteriana de mulheres em idade fértil. Método: estudo transversal, retrospectivo, realizado em uma unidade de saúde de um município do interior paulista. Foram inclusas no estudo as informações de 1173 mulheres submetidas à coleta dos exames citopatológico e esfregaço vaginal corado com técnica de Gram (exame padrão referência para diagnóstico de vaginose bacteriana) e análise a partir do score de Nugent, no período de janeiro de 2013 a junho de 2020. Utilizaram-se dados secundários, coletados a partir dos sistemas de informação e controle interno. Resultados: a prevalência de vaginose bacteriana na amostra foi de 31,8%. O grau de concordância entre os dois métodos diagnósticos pelo índice de Kappa foi de 0,54, considerado moderado, com valor<0,001. A Sensibilidade foi de 55,2% e a Especificidade de 94,1%, com Acurácia de 81,7% e Valor Preditivo Positivo de 81,4% e Negativo de 81,8%. Conclusão: o exame citopatológico apresentou concordância com o padrão referência de 0,77, no entanto, não substitui o esfregaço vaginal corado com técnica de Gram, mas pode ser utilizado como método auxiliar para o diagnóstico de vaginose bacteriana.

Instrumentos preditores de risco para lesão por pressão em pacientes críticos / Instrumentos predictores de riesgo de úlcera por presión en pacientes críticos / Risk predictor instruments for pressure injuries in critically ill patients

Resumo Objetivo Identificar, entre os instrumentos de predição de risco para lesão por pressão (LP) Waterlow, Cubbin & Jackson e EVARUCI , o mais específico e sensível para pacientes em Unidades de Terapia Intensiva (UTI). Métodos Estudo observacional, analítico e prospectivo, realizado em duas UTIs de São Paulo, Brasil, de agosto a novembro de 2019. Participaram 91 pacientes adultos que não apresentavam LP no momento da admissão na UTI e internados na UTI por mais de 24 horas. Os dados foram coletados de prontuários e por meio de avaliação clínica. A associação entre as variáveis clínicas, pessoais e a ocorrência de LP foi feita pelo Teste T-Student e Qui-quadrado e a sensibilidade e a especificidade dos instrumentos foram valiadas por meio da curva ROC. Resultados Houve predominância do sexo masculino (54,9%), média de idade de 66,2 ± 20,8 anos e de internação por razões clínicas (64,9%). O uso de drogas vasoativas, ventilação mecânica, contenção mecânica, sedação, dispositivos, a gravidade e procedência foram associados ao desenvolvimento de LP. A área sob a curva da Cubbin & Jackson, EVARUCI e Waterlow foram respectivamente 0,91, 0,96 e 0,76; e a EVARUCI demonstrou a maior acurácia (90,1%). Conclusão Os instrumentos Cubbin & Jackson e EVARUCI apresentaram alta sensibilidade e especificidade para avaliação de risco para LP em pacientes internados em UTIs, sendo que a EVARUCI mostrou melhor acurácia.

Resumen Objetivo Identificar, entre los instrumentos de predicción de riesgo de úlcera por presión (UP) Waterlow, Cubbin & Jackson y EVARUCI , cuál es el más específico y sensible para pacientes en Unidad de Cuidados Intensivos (UCI). Métodos Estudio observacional, analítico y prospectivo, realizado en dos UCI de São Paulo, Brasil, de agosto a noviembre de 2019. Participaron 91 pacientes adultos que no presentaban UP en el momento de la admisión a la UCI e internados en la UCI por más de 24 horas. Los datos fueron recopilados de las historias clínicas y por medio de evaluación clínica. La asociación entre las variables clínicas, personales y los casos de UP fue realizada por el test-T Student y ji cuadrado, y la sensibilidad y especificidad de los instrumentos fueron validadas mediante la curva ROC. Resultados Hubo predominancia de sexo masculino (54,9 %), promedio de edad de 66,2 ± 20,8 años y de internación por razones clínicas (64,9 %). El uso de drogas vasoactivas, ventilación mecánica, contención mecánica, sedación, dispositivos, la gravedad y procedencia se asociaron a la aparición de UP. El área bajo la curva de Cubbin & Jackson fue 0,91, de EVARUCI fue 0,96 y de Waterlow fue 0,76. El EVARUCI demostró la mayor precisión (90,1 %). Conclusión Los instrumentos Cubbin & Jackson y EVARUCI presentaron alta sensibilidad y especificidad para la evaluación de riesgo de UP en pacientes internados en UCI, de los cuales el EVARUCI demostró una mejor precisión.

Abstract Objective To identify, among the Waterlow, Cubbin & Jackson and EVARUCI risk prediction instruments for pressure injuries (PI), the most specific and sensitive for patients in Intensive Care Units (ICU)). Methods This is an observational, analytical and prospective study, carried out in two ICUs in São Paulo, Brazil, from August to November 2019. Participants were 91 adult patients who did not have PI at the time of admission to the ICU and who had been hospitalized in the ICU for more than 24 hours. Data were collected from medical records and through clinical assessment. The association between clinical and personal variables and PI occurrence was performed using Student's t test and chi-square test, and the instruments' sensitivity and specificity were assessed using the ROC curve. Results There was a predominance of males (54.9%), mean age of 66.2 ± 20.8 years and hospitalization for clinical reasons (64.9%). Vasoactive drug use, mechanical ventilation, mechanical restraint, sedation, devices, severity and origin were associated with PI development. The area under the curve for Cubbin & Jackson, EVARUCI and Waterlow were, respectively, 0.91, 0.96 and 0.76, and EVARUCI demonstrated the highest accuracy (90.1%). Conclusion The Cubbin & Jackson and EVARUCI instruments showed high sensitivity and specificity for PI risk assessment in patients admitted to ICUs, and EVARUCI showed better accuracy.

Rinitis alérgica, apnea-hipopnea obstructiva del sueño y sensibilización a ácaros / Allergic rhinitis, obstructive sleep apnea-hypopnea and mite sensitization

La asociación de rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño se presenta en diferentes edades. En la rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño, puede estar involucrada la sensibilización a ácaros, principalmente: Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis. Con el objetivo de diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño se seleccionaron 120 individuos del registro de alergia del Policlínico Previsora, Camagüey, Cuba, con diagnóstico presuntivo de rinitis alérgica y edad entre 5 y 15 años cumplidos. Todos tenían realizada la prueba de punción cutánea con Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis; algunos también, la poligrafía cardiorrespiratoria mediante el dispositivo ApneaLinkAirTM (Resmed Corp., RFA), utilizando el marcaje automático de eventos. La muestra fue de 40 casos (respiración oral, ronquidos) y 80 controles (sin respiración oral, ni ronquidos). La media del tamaño del habón fue de 7,9 mm en los casos y 4,1 mm en los controles (p꞊0,030). El índice de apnea-hipopnea fue positivo en 47 (39,1 por ciento) pacientes, de ellos, 36 (30 por ciento) casos y 11 (9,1 por ciento) controles (p=0,001). La sensibilidad y especificidad de la poligrafía cardiorrespiratoria mostró valores de 85,00 por ciento y 91,25 por ciento respectivamente que permiten afirmar el grado de eficacia de la prueba para diagnosticar apnea e hipopnea obstructiva del sueño. Los pacientes con síndrome de apnea-hipopnea obstructiva del sueño en los casos y controles presentaron incremento, con predominio para casos. La poligrafía cardiorrespiratoria con el dispositivo ApneaLink permite hacer el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño en rinitis alérgica(AU)

The association of allergic rhinitis and obstructive sleep apnea-hypopnea syndrome occurs at different ages. In allergic rhinitis and obstructive sleep apnea-hypopnea syndrome, sensitization to mites may be involved, mainly: Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis. With the objective to diagnose obstructive sleep apnea-hypopnea syndrome, 120 individuals were selected from the allergy registry of the Previsora Polyclinic, Camagüey, Cuba, with a presumptive diagnosis of allergic rhinitis and ages between 5 and 15 years old. All had the skin prick test with Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis; some also, cardio-respiratory polygraphy with the ApneaLink AirTM device (Resmed Corp., RFA), using automatic event marking. The sample consisted of 40 cases (oral breathing, snoring) and 80 controls (no oral breathing or snoring). The mean size of the wheal was 7.9 mm in the cases and 4.1 mm in the controls (p꞊0.030). The apnea and hypopnea index was positive in 47 (39.1 percent) patients, of which 36 (30 percent) were cases and 11 (9.1 percent) were controls (p=0.001). The sensitivity and specificity of the cardiorespiratory polygraphy showed values of 85.00 percent and 91.25 percent, respectively, which allow affirming the degree of efficacy of the test to diagnose obstructive sleep apnea-hypopnea. Patients with obstructive sleep apnea-hypopnea syndrome in cases and controls presented an increase, with a predominance for cases. Cardiorespiratory polygraphy with the ApneaLink device allows the diagnosis of obstructive sleep apnea-hypopnea syndrome in allergic rhinitis(AU)

Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias / Use of predictive scales for pulmonary thromboembolism in an emergency department

Antecedentes y objetivo: Diagnosticar la tromboembolia pulmonar (TEP) es difícil. Existen escalas de probabilidad clínica (EPC) que ayudan. Se quiere averiguar cuál es mejor.Pacientes y métodosSe realizó un estudio unicéntrico transversal retrospectivo que evaluó la validez de 4 EPC en 200 pacientes en los que se realizó una tomografía computarizada de arterias pulmonares: criterios Pulmonary Embolism Rule out Criteria (PERC), Wells, Ginebra y YEARS. Se estimó su grado de uso, y la posible correlación entre su puntuación y el dímero D (DD).ResultadosLas 4 EPC tienen una alta sensibilidad, cercana a uno y sin diferencias entre ellas. La escala YEARS resultó ser entre 2 y 4 veces más específica que las otras 3. El grado de uso de las escalas se estimó en un 14% (IC 95%: 9,19-18,81). Se halló una débil correlación positiva entre la puntuación de las escalas Wells y Ginebra y el DD.ConclusionesLa escala YEARS se muestra mejor que las demás por su potencial mayor número de pruebas de imagen evitadas y el grado de aplicación de las EPC es mejorable. (AU)

Background and objective: Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best.Patients and methodsA retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer).ResultsThe four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD.ConclusionsThe YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved. (AU)

Validación clínica de la prueba RT-LAMP para el diagnóstico rápido del SARS-CoV-2 / Clinical validation of the isothermal RT-LAMP test for rapid diagnosis of SARS-CoV-2

Introducción. Desde el primer reporte en la provincia de Wuhan (China) en el año 2019, el SARS-CoV-2 se ha diseminado por todo el mundo, provocando un enorme impacto en la salud pública. Para su diagnóstico, la Organización Mundial de la Salud ha incentivado el desarrollo de pruebas rápidas, de simple ejecución, sensibles y específicas, que complementan la RT-qPCR como prueba de referencia. La prueba RT-LAMP ha mostrado ser una excelente alternativa para la detección del SARS-CoV-2 en diferentes biofluidos. Objetivo. Validar la técnica RT-LAMP colorimétrica en muestras de hisopado nasofaríngeo previamente confirmadas por RT-qPCR, usando el protocolo Charité, Berlín, Alemania. Materiales y métodos. Un total de 153 muestras de hisopado nasofaríngeo de individuos con sospecha de COVID-19 se sometieron a RT-qPCR y RT-LAMP, usando un estuche comercial colorimétrico (NEB, Germany). La RT-LAMP se practicó con las muestras de ARN extraídas del hisopado nasofaríngeo y con muestras crudas sin previa extracción de ARN. El resultado fue evaluado por un simple cambio de color en la reacción. Resultados. La sensibilidad y especificidad de la técnica RT-LAMP para detectar el gen N del SARS-CoV-2 mediante un set de cebadores previamente reportados (set de Broughton), arrojó valores de 0,97 (0,85-1,00) y 0,81 (0,65-0,92), respectivamente, con un intervalo de confianza del 95%. Otro set de cebadores dirigidos contra otra región del mismo gen (set de Lalli) arrojó valores de sensibilidad y especificidad de 0,96 (0,78-1,00) y 0,77 (0,55-0,92), respectivamente. Sin previa extracción de ARN, se encontró que la sensibilidad fue del 0,95 (0,74-1,00) y la especificidad del 0,88 (0,64-0,99). Conclusiones. Estos resultados evidencian que la técnica RT-LAMP podría considerarse una prueba diagnóstica rápida, de fácil ejecución, libre de equipos sofisticados, sensible y específica, para el diagnóstico del SARS-CoV-2 en muestras de hisopados nasofaríngeos.

Introduction: Since the first report in Wuhan (China) in 2019, the SARS-CoV-2 virus has spread throughout the world, with a significant impact in public health. To contain its transmission, the WHO has encouraged the development of rapid, simple, sensitive and specific tests that complement qRT-PCR, as the gold standard. RT-LAMP has shown to be a good alternative to detect SARS-CoV-2 in different fluid samples. Objective: To validate the colorimetric RT-LAMP technique using two sets of primers targeting N gene of SARS-CoV-2 in 117 nasopharyngeal swab samples previously confirmed by RT-qPCR, using the Charité/Berlin protocol. Material and methods: A total of 153 nasopharyngeal swab samples from individuals with suspected COVID-19 were subjected to qRT-PCR and RT-LAMP using a commercial colorimetric kit (NEB, Germany). RT-LAMP was performed using both extracted RNA samples and raw samples without prior RNA extraction, and the result was assessed by a simple color change in the reaction. Results: Sensitivity and specificity for the previously reported RT-LAMP primers (Broughton set) targeting N gene of SARS-CoV-2 were 0.97 (0.85-1.00) and 0.81 (0.65-0.92) respectively, with CI95%. The Lalli primers targeting another region of the N gene used showed a sensitivity value of 0.96 (0.78-1.00) and a specificity of 0.77 (0.55-0.92). Without RNA extraction we found a sensitivity value of 0.95 (0.74, 1.00) and a specificity of 0.88 (0.64, 0.99). A sensitivity value of 0.95 (0.74-1.00) and a specificity 0.88 (0.64-0.99) were found without prior RNA extraction. Conclusion: Taking together, the results showed that RT-LAMP technique could be considered as a rapid diagnostic test, easy to perform, free of sophisticated equipment, sensitive and specific to diagnose SARS-CoV-2 in nasopharyngeal swabs with and without prior RNA extraction, allowing its implementation in places with scarce resources.

Use of predictive scales for pulmonary thromboembolism in an emergency department. / Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias.

BACKGROUND AND OBJECTIVE: Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best. PATIENTS AND METHODS: A retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer). RESULTS: The four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD. CONCLUSIONS: The YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved.

Comparative evaluation of dental pulp tests in pulpal status diagnostics / Evaluación comparativa de pruebas de pulpa dental en el diagnóstico del estado pulpar

Introduction: The purpose of this study was to evaluate the effectiveness and compare the accuracy of pulp tests in the diagnosis of teeth pulpal health. Material and Methods: Traumatized (n=71) and non-traumatized (n=71) teeth from 42 patients were evaluated. Each tooth underwent cold, heat, electric and oximetry tests, followed by radiographic examination and calculation of the sensitivity, specificity, PPV, NPV and accuracy. Results: Clinical and radiographic examination showed no alteration for the 71 teeth from the intact contralateral group. From the traumatized group, 29 teeth presented complete endodontic treatment, 17 presented periapical alterations that required endodontic treatment and 25 teeth did not present conclusive radiographic alteration. The cold test showed a significantly higher proportion of correct results, while the electric test showed a significantly lower proportion. The data showed higher accuracy for the cold, followed by oximeter and heat tests, while the electric test presented the lowest accuracy. Cold and oximeter tests proved superior over the electric and heat tests, while the electric test showed better parameters when diagnosing diseased pulp. Conclusion: Combining two pulp tests seems reasonable for improving the pulp diagnoses using both oximeter and cold or oximeter and heat tests to detect healthy pulp; or cold and electric tests to define diseased pulp.

Introducción: El propósito de este estudio fue evaluar la efectividad y comparar la precisión de las pruebas pulpares en el diagnóstico de la salud pulpar de los dientes. Material y Métodos: Se evaluaron dientes traumatizados (n=71) y no traumatizados (n=71) de 42 pacientes. Cada diente se sometió a pruebas de frío, calor, eléctricas y de oximetría, seguidas de examen radiográfico y cálculo de la sensibilidad, especificidad, VPP, VPN y precisión. Resultados: El examen clínico y radiográfico no mostró alteración en los 71 dientes del grupo contralateral intacto. Del grupo traumatizado, 29 dientes presentaron tratamiento endodóntico completo, 17 presentaron alteraciones peri-apicales que requirieron tratamiento endodóntico y 25 dientes no presentaron alteración radiográfica concluyente. La prueba en frío mostró una proporción significativamente mayor de resultados correctos, mientras que la prueba eléctrica mostró una proporción significativamente menor. Los datos mostraron mayor precisión para la prueba de frío, seguida de las pruebas de oxímetro y calor, mientras que la prueba eléctrica presentó la menor precisión. Las pruebas de frío y oxímetro demostraron ser superiores a las pruebas eléctricas y de calor, mientras que la prueba eléctrica mostró mejores parámetros al momento de diagnosticar pulpa enferma. Conclusión: La combinación de dos pruebas pulpares parece razonable para mejorar los diagnósticos pulpares utilizando tanto el oxímetro como las pruebas de frío u oxímetro y calor para detectar una pulpa sana; o pruebas de frío y eléctricas para definir pulpa enferma.