NEWS2, S/F-ratio and ROX-index at emergency department for the prediction of adverse outcomes in COVID-19 patients: An external validation study.

BACKGROUND: In the context of the COVID-19 pandemic, the early and accurate identification of patients at risk of deterioration was crucial in overcrowded and resource-limited emergency departments. This study conducts an external validation for the evaluation of the performance of the National Early Warning Score 2 (NEWS2), the S/F ratio, and the ROX index at ED admission in a large cohort of COVID-19 patients from Colombia, South America, assessing the net clinical benefit with decision curve analysis. METHODS: A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality. RESULTS: We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35-65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility. CONCLUSIONS: The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings.

Outcomes of endoscopic treatment for early correction of craniosynostosis in children: a 26-year single-center experience.

OBJECTIVE: Surgery is the cornerstone of craniosynostosis treatment. In this study, two widely accepted techniques are described: endoscope-assisted surgery (EAS) and open surgery (OS). The authors compared the perioperative and reconstructive outcomes of EAS and OS in children ≤ 6 months of age treated at the Napoleón Franco Pareja Children's Hospital (Cartagena, Colombia). METHODS: According to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement, patients with defined criteria who underwent surgery to correct craniosynostosis between June 1996 and June 2022 were retrospectively enrolled. Demographic data, perioperative outcomes, and follow-up were obtained from their medical records. Student t-tests were used for significance. Cronbach's α was used to assess agreement between estimated blood loss (EBL). Spearman's correlation coefficient and the coefficient of determination were used to establish associations between the results of interest, and the odds ratio was used to calculate the risk ratio of blood product transfusion. RESULTS: A total of 74 patients met the inclusion criteria; 24 (32.4%) belonged to the OS group and 50 (67.6%) to the EAS group. There was a high interobserver agreement quantifying the EBL. The EBL, transfusion of blood products, surgical time, and hospital stay were shorter in the EAS group. Surgical time was positively correlated with EBL. There were no differences between the two groups in the percentage of cranial index correction at 12 months of follow-up. CONCLUSIONS: Surgical correction of craniosynostosis in children aged ≤ 6 months by EAS was associated with a significant decrease in EBL, transfusion requirements, surgical time, and hospital stay compared with OS. The results of cranial deformity correction in patients with scaphocephaly and acrocephaly were equivalent in both study groups.

Clinical profile of dengue in patients consulting a tertiary hospital in the city of Cali, Colombia, 2013.

INTRODUCTION: Dengue virus infection is amongst the most important arboviral diseases in the country and has become a major global public health concern.  OBJECTIVE: To describe the clinical profile of patients with dengue virus infection hospitalized in a tertiary hospital in the city of Cali, Colombia. We also describe the trend analysis of the number of cases by epidemiological weeks in 2013.  MATERIALS AND METHODS: We conducted a retrospective study of admitted patients suspected to have dengue infection in the Rafael Uribe Uribe Clinic in the year 2013. Patients with serological confirmation of dengue infection were classified according to the World Health Organization classification. Subsequently, the clinical parameters of the patients with dengue were described.  RESULTS: Of the 1,173 patients with suspected dengue, 287 (24.5%) were confirmed serologically; 152 (53%) were women and 135 (47%) males; 40.1% had no warning signs, 3.8% had warning signs and 25.1% had severe manifestations. The most common symptoms were fever (287;100%), myalgia (223;78%), and headache (183:64%). Hemorrhagic manifestations were recorded in 100 (34.8%) patients; 4 (1.4%) had neurological manifestations. Three deaths (0.7%) were reported, two of which were associated with sickle cell disease.  CONCLUSIONS: The severe form of the infection and mortality from dengue reported during the outbreak was more frequent in the pediatric population. It is suggested to implement strategies to ensure specific attention to patients with comorbidities such as sickle cell disease.

Caracterización clínica de pacientes que consultaron por dengue en un hospital de tercer nivel en Cali, Colombia, 2013 / Clinical profile of dengue in patients consulting a tertiary hospital in the city of Cali, Colombia, 2013

Introducción. La infección por el virus del dengue es una de las arbovirosis más importantes en el país y es un grave problema de salud pública. Objetivo. Determinar las características clínicas y los resultados de los exámenes de laboratorio de los pacientes que consultaron por dengue en la Clínica Universitaria Rafael Uribe Uribe de Cali, y analizar la tendencia del número de casos por semanas epidemiológicas durante el 2013. Materiales y métodos. Se hizo un estudio observacional retrospectivo de los pacientes que ingresaron con sospecha de dengue a la Clínica Rafael Uribe Uribe de Cali durante el 2013. Los pacientes con diagnóstico confirmado de infección por dengue se clasificaron de acuerdo con las definiciones de la Organización Mundial de la Salud y, posteriormente, se describieron los parámetros clínicos que presentaban. Resultados. Se notificaron 1.173 casos sospechosos, de los cuales 287 (24,5 %) fueron confirmados por serología; 152 (53,0 %) eran mujeres y 135 (47,0 %), hombres; 40,1 % no presentaba signos de alarma, 34,8 % sí y 25,1 % tuvo manifestaciones graves . Los síntomas más frecuentes fueron la fiebre (287; 100 %), las mialgias (223; 78,0 %), y la cefalea (183; 64,0 %). Las manifestaciones hemorrágicas se presentaron en 100 (34,8 %) de los pacientes. Cuatro pacientes (1,4 %) presentaron manifestaciones neurológicas. Se reportaron tres muertes (0,7 %), dos de las cuales se asociaron a la drepanocitosis. Conclusiones. La forma grave de la infección y la mortalidad que causó durante el periodo de estudio fueron más frecuentes en la población pediátrica. Se sugiere la implementación de estrategias que garanticen la atención específica de los pacientes con enfermedades concomitantes, como la drepanocitosis.

Introduction: Dengue virus infection is amongst the most important arboviral diseases in the country and has become a major global public health concern. Objective: To describe the clinical profile of patients with dengue virus infection hospitalized in a tertiary hospital in the city of Cali, Colombia. We also describe the trend analysis of the number of cases by epidemiological weeks in 2013. Materials and methods: We conducted a retrospective study of admitted patients suspected to have dengue infection in the Rafael Uribe Uribe Clinic in the year 2013. Patients with serological confirmation of dengue infection were classified according to the World Health Organization classification. Subsequently, the clinical parameters of the patients with dengue were described. Results: Of the 1,173 patients with suspected dengue, 287 (24.5%) were confirmed serologically; 152 (53%) were women and 135 (47%) males; 40.1% had no warning signs, 3.8% had warning signs and 25.1% had severe manifestations. The most common symptoms were fever (287;100%), myalgia (223;78%), and headache (183:64%). Hemorrhagic manifestations were recorded in 100 (34.8%) patients; 4 (1.4%) had neurological manifestations. Three deaths (0.7%) were reported, two of which were associated with sickle cell disease. Conclusions: The severe form of the infection and mortality from dengue reported during the outbreak was more frequent in the pediatric population. It is suggested to implement strategies to ensure specific attention to patients with comorbidities such as sickle cell disease.

Edema Pulmonar por Pressão Negativa (EPPN) em pós-operatório imediato de rinosseptoplastia: relato de caso e revisão da literatura / Negative Pressure Pulmonar Edema(NPPE) in pos-operatory rinosseptoplasty: case report and literature review

O Edema Pulmonar por Pressão Negativa (EPPN) figura como entidade rara, porém bem descrita na literatura. Decorre de episódios de obstrução aguda das vias aéreas, sendo potencialmente fatal, quando não reconhecido ou mal diagnosticado. Este relato revisa os dados científicos sobre taxa de incidência, fisiopatologia, diagnóstico e abordagem do paciente com edema pulmonar. A real incidência do edema pulmonar agudo nos pacientes submetidos à anestesia geral é desconhecida e variável, mas é próximo de 0,05 a 0,1 por cento. A fisiopatologia é decorrente de alteração nas forças de Starling, que influenciam movimento de fluidos nos capilares pulmonares. O diagnóstico é baseado nos aspectos clínicos do paciente. A abordagem terapêutica engloba desde o uso de FiO2 a 100 por cento e reintubação até administração endovenosa de furosemida, morfina e nitroglicerina. É apresentado relato de um paciente que evoluiu com EPPN em pós-operatório imediato de rinosseptoplastia. É necessário o diagnóstico preciso e precoce do EPPN, devendo ser considerado complicação potencial em pacientes jovens e saudáveis, no período imediato pós-extubação e de recuperação após anestesias gerais com ventilação mecânica. O rápido reconhecimento da situação, reversão da obstrução e aplicação de ventilação com pressão positiva possibilitam a abordagem eficaz e podem prevenir a necessidade de medidas mais invasivas.