C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain.

OBJECTIVE: To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS: An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS: Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = 0.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P < 0.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < 0.05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P > 0.05 vs AUC-ROC development). CONCLUSION: Patients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9.1 mg/mL could be at high risk to require critical care.

C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain. / Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España.

OBJECTIVE: To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS: An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS: Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P=.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P<.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P<.05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P>0.05 vs AUC-ROC development). CONCLUSION: Patients COVID-19 presenting at admission SOFA score ≥2 combined with CRP ≥9,1mg/mL could be at high risk to require critical care.

[C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain]. / Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España.

OBJECTIVE: To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS: An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤ 6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS: Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = .0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P < .0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < .05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P > 0.05 vs AUC-ROC development). CONCLUSION: Patients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9,1 mg/mL could be at high risk to require critical care.

Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients.

BACKGROUND: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. METHODS: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. RESULTS: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). CONCLUSION: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.

ANTECEDENTES: La estratificación de la gravedad de una infección se basa actualmente en la puntuación SOFA (Sequential Organ Failure Assessment), que es difícil de calcular fuera de la unidad de cuidados intensivos. Los biomarcadores podrían ayudar a estratificar la gravedad de la infección en pacientes quirúrgicos. MÉTODOS: Se compararon las concentraciones de 10 biomarcadores que denotan disfunción endotelial, 22 que indican granulopoyesis de emergencia y 6 que expresan la degranulación de neutrófilos en tres grupos de pacientes de tres hospitales españoles (100 con infección, 95 con sepsis y 57 con shock séptico) en las primeras doce horas después del diagnóstico. RESULTADOS: Siete biomarcadores que expresan disfunción endotelial (proadrenomedulina, sindecan-1, trombomodulina, angiopoyetina-2, endocan-1, molécula de adhesión endotelial 1 y E-selectina) mostraron una fuerte asociación con la sepsis en comparación con la infección aislada. La proadrenomedulina presentó el valor más alto de la razón de oportunidades (odds ratio, OR) en el análisis multivariable (OR 11,53, i.c. del 95% 4,15-32,08, P = 0,006) y la mejor área bajo la curva para detectar sepsis (AUC 0,86, i.c. del 95% 0,80-0,91, P < 0,001). En la comparación entre sepsis y shock séptico, los biomarcadores que mostraron la asociación más estrecha con el shock séptico fueron dos biomarcadores de degranulación de neutrófilos (proteinasa-3 y lipocalina-2) (OR 8,09, i.c. del 9% 1,34-48,91, P = 0,028; OR 6.62, i.c. del 95% 2,47-17,77, P = 0,002), pero la lipocalina-2 presentó la mejor AUC (0,81, i.c. del 95% 0,73-0,90, P < 0,001). CONCLUSIÓN: la proadrenomedulina y la lipocalina-2 podrían representar alternativas a la puntuación SOFA para detectar sepsis y shock séptico en pacientes quirúrgicos con infección.

Masa cervical gigante. Un reto anestésico / Giant cervical mass. An anesthetic challenge

No disponible

Estudio del patrón de presiones plantares en pies con hallux valgus mediante un sistema de plantillas instrumentadas / Study of plantar pressure patterns by means of instrumented insoles in subjects with hallux valgus

Introducción. Las presiones que soporta el antepié en una patología como el hallux valgus ha sido un tema discutido, con resultados dispares. Este artículo pretende comparar las presiones soportadas por el antepié en un grupo de pies normales y en un grupo de pies con hallux valgus leves o moderados. Material y métodos. Se realiza un estudio en 60 sujetos (30 con hallux valgus y 30 con pies sanos), que son analizados con el sistema Biofoot/IBV de plantillas instrumentadas. El sistema emplea unas finas plantillas (0,7 mm de grosor) con 64 sensores piezoeléctricos. Se analiza la presión máxima en siete regiones, las cinco cabezas metatarsales, el hallux y los dedos menores. Resultados. Los picos máximos de presión en el grupo control se localizaron significativamente en segunda y tercera cabeza metatarsal (p = 0,001). El grupo de pies con hallux valgus registraron picos en la primera cabeza y en el ha- llux (p = 0,001). La localización de los picos de presión en el primer radio sugiere la pronación como factor desencadenante del hallux valgus. Conclusiones. Los sistemas de plantillas instrumentadas son excelentes para analizar las presiones normales y patológicas. Son necesarios estudios más amplios para llegar a conclusiones más precisas. Se abren diferentes vías de investigación, como el estudio de las presiones a cadencias y velocidades determinadas y con diferentes calzados

Introduction. The pressures exerted on the forefoot in a condition like hallux valgus have been the subject of much debate, with dissimilar results. This article aims to compare the pressures borne by the forefoot in a group of normal feet with those it bears in a group of feet with mild or moderate hallux valgus. Materials and methods. A study was performed of 60 subjects (30 with hallux valgus and 30 with normal feet), who were analyzed with the Biofoot/IBV instrumented insole system. The system uses a series of thin insoles (0.7 mm-thick) with 64 piezoelectric sensors. Maximum pressure was analyzed in seven regions, i.e. the five metatarsal heads, the hallux and the lesser rays. Results. Maximum pressure peaks in the control group were measured significantly in the second and third metatarsal heads (p = 0.001). The hallux valgus group had its pressure peaks at the first metatarsal head and at the hallux (p = 0.001). The presence of pressure peaks at the first ray points to pronation as the factor leading to hallux valgus. Conclusions. Instrumented insole systems are an excellent tool to analyze normal and pathological pressures. More detailed studies are necessary to come to more definite conclusions. In future, different research ways could be followed such as the study of pressures at pre-established values of cadence and speed of gait and with different kinds of footwear

Estudio baropodométrico de los valores de presión plantar en pies no patológicos / Baropodometry study of plantar pressure values in normal feet

Introducción. El objetivo de este estudio fue evaluar las presiones plantares normales en sujetos sanos mediante baropodometría electrónica. Material y métodos. Cuarenta y seis sujetos sanos fueron analizados con el sistema Biofootì de plantillas instrumentadas. El sistema emplea unas plantillas con 64 sensores piezoeléctricos. Se midieron las presiones en el talón, mediopié y antepié en 6 segundos de grabación para cada sujeto. El pico de presión máxima y la presión media fue calculado y analizado. Resultados. La media del tiempo de contacto fue de 0,81 segundos (desviación estándar [DE] 0,08) en el pie derecho, y 0,82 segundos (DE 0,09) en el izquierdo. La cadencia fue de 105,6 (± 8,4) pasos por minuto. El pico máximo de presión y presión media en el retropié fue de 750 y 253 kPa, respectivamente. En el mediopié el pico de presión fue de 400 kPa y la presión media de 65 kPa. En el antepié los valores encontrados fueron de 1.240 kPa para el pico de presión y de 220 kPa para la presión media. Discusión. Los picos de presión más elevados se encontraron en el antepié, seguidos del retropié y por último en el mediopié. En relación a la presión media, el porcentaje de apoyo del talón es del 46,4 %, el del mediopié de un 12 % y el del antepié de un 41,6 %. Con el número de pacientes analizados no se encontró correlación entre cadencia y presiones, aunque el peso presentaba una correlación significativa y positiva con los valores de presión en todas las zonas

Background. This study aimed to evaluate normal plantar pressures in healthy subjects using an electronic baropodometry. Material and methods. Forty-six healthy subjects, with no clear foot or lower limb diseases, were analyzed with the Biofootì (IBV, Valencia, Spain) in-shoe system. The Biofoot system uses insoles with 64 piezoelectric sensors. Heel, midfoot and forefoot pressures were measured in 6 second recordings for each subjects. Maximum pressure peak and mean pressure was calculated and analyzed. Results. Mean contact time was 0.81 (standard deviation [SD] 0.08) seconds in the right foot and 0.82 (SD 0.09) seconds in the left foot. Walking cadency was 105.6 (SD 8.4) steps per minute. Maximum peak and mean pressure in the heel was 750 and 253 kPa, respectively. In the midfoot, peak pressure was 400 kPa and mean pressure 65 kPa. The values found in the forefoot was 1,240 kPa for pressure peak and 220 kPa for mean pressure. Discussion. The highest pressure peaks were found in the forefoot, followed by the heel and finally in the midfoot. In relationship to mean pressure, percentage of heel support is 46.4 %, that of the midfoot 12 % and forefoot 41.6 %. No correlation was found between cadence and pressure values with the number of patients analyzed in this study, however, there was a significant and positive correlation of weight with the pressure values in all the regions

Bloqueo del ganglio estrellado y anestesia subaracnoidea. Caso Clínico / No disponible

El ganglio estrellado está formado por la unión del ganglio cervical inferior y el primer ganglio torácico. El bloqueo de dicho ganglio es usado para el diagnóstico y tratamiento de diversos síndromes dolorosos crónicos. Esta técnica con anestésicos locales suele ser segura aunque no exenta de complicaciones como convulsiones, neumotórax o anestesia espinal entre otras. Estas complicaciones pueden minimizarse con una adecuada vigilancia, monitorización y recursos adecuados. Para un correcto diagnóstico y tratamiento de las posibles complicaciones. Presentamos el caso de un bloqueo espinal completo tras la realización de un bloqueo del ganglio estrellado (AU)

The stellate ganglion refers to the ganglion formed by fusion of the inferior cervical and the first thoracic ganglion. Stellate ganglion blockade is a procedure mainly used for the diagnosis and treatment of chronic painful syndromes. This technique with local anesthetic is a safe procedure, his risk, though infrequent; include seizures, pneumothorax, spinal block and others. These complications can be minimized with adequate monitoring, surveillance and resources in order to diagnostic and treatment of complications. We present a case with spinal block following stellate ganglion blockade (AU)

Ketamina oral: alternativa válida en el tratamineto del dolor facial atípico. A propósito de un caso / Oral ketamine: a valid option for the management of atypical facial pain. A case report

Paciente varón de 42 años con antecedentes de displasia fibrosa etmoidal, en tratamiento en la Unidad del Dolor por cefalea atípica "en antifaz". Fue sometido a diversos tratamientos, no obteniendo mejoría alguna, por lo que se inicia tratamiento con antagonistas de receptores NMDA (ketamina), inicialmente por vía subcutánea y tras comprobar su eficacia se pasó a vía oral obteniendo un efecto antiálgico adecuado con una mejoría del 80 por ciento, valorada por el propio paciente. Podemos concluir que el empleo de ketamina oral es una alternativa válida en el tratamiento del dolor facial atípico tras el fracaso de diversas medidas terapéuticas (AU)

[Changes in the immunologic status related to the duration of the anesthesia/surgery procedure]. / Alteraciones del estado inmunológico en función de la duración del acto anestésico-quirúrgico.

OBJECTIVE: To study the effect of the trauma of anesthesia and surgery, and their duration, on immune status. PATIENTS AND METHODS: Fifty patients undergoing cholecystectomy were studied in 2 groups. In group A surgery was of short duration ( < 60 min) and in group B surgery was longer ( > 60 min). Immunological analysis were performed at 5 times: t0 (before surgery), t1 (1 h), t2 (24 h), t3 (4 days) and t4 (7 days). RESULTS: Group A patients experienced a non significant decrease in T lymphocytes, activated T lymphocytes and B lymphocytes, with levels returning to normal after 7 days. T-suppression, on the other hand, decreased significantly in the first 24 h, but gradually returned to normal after 7 days. T lymphocytes, activated T lymphocytes and B lymphocytes decreased in group B and regressed after 7 days. The population of B lymphocytes decreased significantly and had not fully recovered 7 days after surgery. CONCLUSIONS: The act of anesthesia/surgery depresses immune response in function of duration, with the effect being greater when surgery lasts longer.

[Effects of thiopental and propofol on suppressor T lymphocyte activity and noradrenaline release]. / Efectos del tiopental y el propofol sobre la actividad T supresora linfocitaria y la liberación de noradrenalina.

The effects of thiopental and propofol on lymphocyte suppressor T activity were studied in the basal state and after 20 min, 24 hours, and 4 days of anesthesia induction in 20 patients undergoing gynaecologic surgery. Both drugs induced a decrease in lymphocyte suppressive T activity which recovered after 4 days and tended to be larger, although not significantly, with thiopental. Serum noradrenaline concentration significantly increased after two hours of propofol anesthesia and after 20 min and 2 hours of thiopental administration. These results demonstrate that the relationship between lymphocyte suppressive T activity and noradrenaline corresponds theoretically to anesthesia deepness.