Stratifying risk outcomes among adult COVID-19 inpatients with high flow oxygen: The R4 score.

BACKGROUND: High flow oxygen therapy (HFO) is a widely used intervention for pulmonary complications. Amid the coronavirus infectious disease 2019 (COVID-19) pandemic, HFO became a popular alternative to conventional oxygen supplementation therapies. Risk stratification tools have been repurposed -and new ones developed- to estimate outcome risks among COVID-19 patients. This study aims to provide a simple risk stratification system to predict invasive mechanical ventilation (IMV) or death among COVID-19 inpatients on HFO. METHODS: Among 529 adult inpatients with COVID-19 pneumonia, we selected unadjusted clinical risk factors for developing the composite endpoint of IMV or death. The risk for the primary outcome by each category was estimated using a Cox proportional hazards model. Bootstrapping was used to validate the results. RESULTS: Age above 62, eGFR under 60 ml/min, room air SpO2 ≤89 % upon admission, history of hypertension, history of diabetes, and any comorbidity (cancer, cardiovascular disease, COPD/ asthma, hypothyroidism, or autoimmune disease) were considered for the score. Each of the six criteria scored 1 point. The score was further simplified into 4 categories: 1) 0 criteria, 2) 1 criterion, 3) 2-3 criteria, and 4) ≥4 criteria. Taking the first category as the reference, risk estimates for the primary endpoint were HR; 2.94 [1.67 - 5.26], 4.08 [2.63 - 7.05], and 6.63 [3.74 - 11.77], respectively. In ROC analysis, the AUC for the model was 0.72. CONCLUSIONS: Our score uses simple criteria to estimate the risk for IMV or death among COVID-19 inpatients with HFO. Higher category reflects consistent increases in risk for the endpoint.

[Tropical pyomyositis of the iliacus, obturator internus, piriformis and psoas major muscles in an immunocompetent patient with claudication]. / Piomiositis tropical del músculo ilíaco, obturador interno, piriforme y psoas mayor en un paciente inmunocompetente con claudicación.

INTRODUCTION: Pyomyositis is a term that denotes pyogenic infection usually primary skeletal muscle, associated with hematogenous dispersion due to transient bacteremia, or penetrating trauma, usually forming abscesses. Classically described frequently in tropical areas and predominantly affecting the lower limb musculature, however, in recent decades it has increasingly been associated with areas of temperate climates and relatively more frequently in immunosuppressed patients, being the patients under 30 years the most affected. CLINICAL CASE: Male of 15 years without relevant medical history. The patient had no history of trauma, falls, surgical interventions, infections or any other systemic condition. He came because of a clinical picture of 7 days of evolution characterized by pain referred to the groin and left iliac crest area associated with claudication and hyperthermia not quantified, which yielded partially to NSAIDs and paracetamol, but without achieving improvement so it is taken emergency by relatives. CONCLUSIONS: It is necessary to bear in mind this pathology when performing the differential diagnostic approach of a patient presenting with pain and functional limitation of some joint associated with data suggestive of an infectious or inflammatory process.

INTRODUCCIÓN: La piomiositis es un término que denota infección piógena por lo general primaria de músculo esquelético. Clásicamente descrita de manera frecuente en zonas tropicales y en pacientes inmunocomprometidos; sin embargo, en las últimas décadas se observa cada vez más en zonas de climas templados y con relativa mayor frecuencia en pacientes inmunocompetentes, siendo el grupo etario más afectado el de menores de 30 años. CASO CLÍNICO: Masculino de 15 años sin antecedentes médicos de relevancia. Acude por presentar cuadro clínico de siete días de evolución caracterizado por dolor referido en ingle y zona de la cresta ilíaca izquierda asociado a claudicación e hipertermia no cuantificada, que cedían parcialmente a AINES y paracetamol, pero sin lograr mejoría, por lo que es llevado a urgencias por familiares. CONCLUSIONES: Es necesario tener en mente esta patología al momento de realizar el abordaje diagnóstico diferencial de un paciente que se presenta con dolor y limitación funcional de alguna articulación asociada a datos sugestivos de un proceso infeccioso o inflamatorio.