Neurological Manifestations and Outcomes in a Retrospective Cohort of Mexican Inpatients with SARS-CoV-2 Pneumonia: Design of a Risk Profile.

We analyzed the neurological manifestations in Mexican patients hospitalized with pneumonia due to COVID-19 and investigated the association between demographic, clinical, and biochemical variables and outcomes, including death. A retrospective, analytical study was conducted using the electronic records of patients hospitalized between 1 April 2020 and 30 September 2020. Records of 1040 patients were analyzed: 31.25% died and 79.42% had neurological symptoms, including headache (80.62%), anosmia (32.20%), ageusia (31.96%), myopathy (28.08%), disorientation (14.89%), encephalopathy (12.22%), neuropathy (5.4%), stroke (1.3%), seizures (1.3%), cerebral hemorrhage (1.08%), encephalitis (0.84%), central venous thrombosis (0.36%), and subarachnoid hemorrhage (0.24%). Patients also had comorbidities, such as hypertension (42.30%), diabetes mellitus (38.74%), obesity (61.34%), chronic obstructive pulmonary disease (3.17%), and asthma (2.01%). Factors associated with neurological symptoms were dyspnea, chronic obstructive pulmonary disease, advanced respiratory support, prolonged hospitalization, and worsening fibrinogen levels. Factors associated with death were older age, advanced respiratory support, amine management, chronic obstructive pulmonary disease, intensive care unit management, dyspnea, disorientation, encephalopathy, hypertension, neuropathy, diabetes, male sex, three or more neurological symptoms, and obesity grade 3. In this study we designed a profile to help predict patients at higher risk of developing neurological complications and death following COVID-19 infection.

[Ambulatory pacemaker surgery]. / Implantación de marcapasos definitivos en programa de cirugía ambulatoria.

The chronic cardiac stimulation is know since 1958, pacemaker implant was considered a difficult procedure that was performed through cardiovascular surgery and the patient required several in hospital days. On the grounds of new surgical techniques and development of new materials for pacemakers, as well as the rise of Ambulatory Surgery and its application in pacemaker implants, the hospital stay and consequently, costs have decreased significantly. In 1986, Zegelman reported 583 patients subjected to ambulatory pacemaker surgery without mortality. The purpose of this report it to evaluate the efficacy and safety of ambulatory pacemaker surgery. One hundred seventy seven patients from an ambulatory program and 95 from a traditional program were included. Hospitalization time was 15.7 +/- 15.1 hours in the first group and 238 +/- 188 hours for the second, prevalence of complications was 2.2% in the 272 patients. Complications for both groups were similar and were solved, without mortality. We conclude that the ambulatory pacemaker surgery is effective and safe for patients and is cheaper for hospitals. The success of this program depends on the number of implants in each hospital and the operator's experience.

Implantación de marcapasos definitivos en programa de cirugía ambulatoria / Ambulatory pacemaker surgery

Desde 1958 se conoce lo que llamamos estimulación cardíaca crónica, inicialmente ésta se consideraba un procedimiento quirúrgico complejo para el cirujano cardiovascular y exigía hospitalización por varios días. Con el desarrollo de nuevas técnicas y de materiales, así como el surgimiento de la cirugía ambulatoria y su aplicación en la implantación de marcapasos, se abatió la estancia hospitalaria y consecuentemente los costos de este procedimiento. Desde 1986 Zegelman describe una serie de 583 casos en los cuales se colocó en forma ambulatoria un marcapaso definitivo, sin reportarse mortalidad. El objetivo del presente estudio fue valorar la eficacia y seguridad de la colocación de marcapasos definitivos en el Programa de Cirugía Ambulatoria. Se incluyeron 177 pacientes en estancia corta y 95 en estancia tradicional; la estancia hospitalaria fue 15.7±15.1 horas para el primer grupo y 238 ±188 horas para el segundo y se presentaron complicaciones en el 2.2% de los 272 pacientes. Las complicaciones fueron similares en ambos grupos y se resolvieron favorablemente, además no hubo mortalidad. Concluimos que la colocación de marcapasos definitivos en Programa de Cirugía Ambulatoria representa una opción segura para el paciente y con menor costo para la institución. Que el éxito de este programa depende del número de implantes de un centro hospitalario y de la experiencia del operador.

The chronic cardiac stimulation is know since 1958, pacemaker implant was considered a difficult procedure that was performed through cardiovascular surgery and the patient required several in hospital days. On the grounds of new surgical techniques and development of new materials for pacemakers, as well as the rise of Ambulatory Surgery and its application in pacemaker implants, the hospital stay and consequently, costs have decreased significantly. In 1986, Zegelman reported 583 patients subjected to ambulatory pacemaker surgery without mortality. The purpose of this report it to evaluate the efficacy and safety of ambulatory pacemaker surgery. One hundred seventy seven patients from an ambulatory program and 95 from a traditional program were included. Hospitalization time was 15.7±15.1 hours in the first group and 238± 188 hours for the second, prevalence of complications was 2.2% in the 272 patients. Complications for both groups were similar and were solved, without mortality. We conclude that the ambulatory pacemaker surgery is effective and safe for patients and is cheaper for hospitals. The success of this program depends on the number of implants in each hospital and the operator's experience.