RESUMO
OBJECTIVES: To determine the risk factors associated with delirium in patients admitted to a COVID-19 Hospitalization of a general hospital during the first year of the COVID-19 pandemic. METHODS: An observational, analytical, case-control study was conducted. We analyzed 50 medical records of patients who presented delirium and 50 who did not present delirium in a COVID Hospitalization area during the period from March 2020 to March 2021. The Odd Ratio of sociodemographic and clinical factors for presenting delirium was evaluated. The logistic regression statistical test was performed using STATA 17.0 software. The protocol was approved by the Research Ethics Committee of the Villa El Salvador Emergency Hospital. RESULTS: Ventilatory support (p=0.04), especially the use of a reservoir mask (OR=0.34, CI 0.12-0.88) and the presence of systemic complications (p=0.03) such as metabolic acidosis (OR=12.9, CI 1.45-115.58) were statistically significant variables associated with a higher risk of presenting delirium. CONCLUSIONS: The type of ventilatory support and the presence of systemic complications were significant risk factors for delirium in patients hospitalized in a COVID area. Further studies are required in this field to obtain more evidence in this regard.
RESUMO
Describimos la presentación clínica y dificultades diagnósticas de un caso de síndrome neuroléptico maligno en un hospital general. El paciente fue un varón de 18 años con diagnóstico de retraso mental grave e historia de convulsiones que recibía tratamiento irregular con risperidona y fenitoína. Tras presentar irritabilidad, agresividad y agitación psicomotriz acude a hospital psiquiátrico en donde le indican incremento de dosis de risperidona. Posteriormente por persistencia de agresividad, acude a hospital psiquiátrico en donde se indicó haloperidol, midazolam y levomepromazina, a los pocos días presentó distonía oro mandibular, alza térmica y distonía generalizada con dificultad para la deglución de alimentos, motivo por el cual acudió a hospital general y fue diagnosticado de síndrome neuroléptico maligno. El paciente recibió tratamiento con bromocriptina y diazepam durante hospitalización y tuvo evolución favorable de síntomas neuropsiquiátricos. El síndrome neuroléptico maligno es un evento adverso raro y fatal. Está asociado al uso de psicotrópicos, especialmente antipsicóticos.
We describe the clinical presentation and diagnostic difficulties of a case of Neuroleptic Malignant Syndrome in a general hospital. The patient was an 18-year-old male with severe mental retardation and a history of seizures who received irregular treatment with risperidone and phenytoin. After presenting irritability, aggressiveness, and psychomotor agitation, he went to a psychiatric hospital where received an increase in the dose of risperidone. Subsequently, due to persistence of aggressiveness, he went to a psychiatric hospital where haloperidol, midazolam and levomepromazine were indicated, after few days developed oromandibular dystonia, temperature rise and generalized dystonia with difficulty swallowing food, which is why he went to hospital general and was diagnosed with Neuroleptic Malignant Syndrome. Patient received treatment with bromocriptine and diazepam during hospitalization with favorable evolution of neuropsychiatric symptoms. Neuroleptic Malignant Syndrome is a rare and fatal adverse event. It is associated with the use of psychotropics, especially antipsychotics.
RESUMO
RESUMEN La enfermedad producida por el SARS-CoV-2 constituye una pandemia declarada con alta contagiosidad y letalidad en grupos de riesgo. En menos de tres meses la humanidad ha tenido que lidiar con este virus sin saber mucho de su patogenia y tratamiento. Se presentan cinco casos atendidos en el Hospital de Emergencias Villa El Salvador (HEVES) en Lima, Perú. Se destaca la importancia de la clasificación clínica en cuatro estadios: leve, moderado, severo y crítico y revisamos el tratamiento antiviral, inmunomodulador y antitrombótico consecuente a tal clasificación. La terapia antiviral con hidroxicloroquina y azitromicina obtuvo resultados favorables en cuatro casos: sobre todo, cuando se inició en los primeros días de enfermedad. Sin embargo, su eficacia es aún controversial y se esperan resultados de ensayos clínicos aleatorizados. Mientras tanto, su uso en fase temprana de la enfermedad, en estadios leves o moderados, debería mantenerse.
ABSTRACT The disease caused by SARS-CoV-2 is a pandemic characterized for being highly contagious and lethal in groups at risk. In less than three months, mankind had to fight against this virus without knowing its pathogenicity and therapy. We present the experience with five cases seen in the Hospital de Emergencias Villa el Salvador in Lima, Peru, and we emphasize the importance of the clinical classification of the disease in four stages: mild, moderate, severe, and critical. We reviewed the current antiviral, immunomodulatory, and antithrombotic therapy approaches. Antiviral therapy using hydroxichloroquine and azithromycin led to favorable outcomes in four cases, particularly when it was early instituted. Nonetheless, its efficacy is still controversial and results from randomized clinical trials are eagerly awaited. Meanwhile, its use during the early phases of mild or moderate disease should be maintained.
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The objective of the study was to determine the frequency and characteristics of dyslipidemia in patients with HIV in highly active antiretroviral therapy (HAART) in a Peruvian public hospital. A cross-sectional study was carried out in patients with complete lipid profile after receiving at least six months of HAART. Dyslipidemia was defined according to the criteria of the NCEP-ATP III. We reviewed 2 975 clinical histories, and included 538 (18.1%) in the analysis. The frequency of dyslipidemia was 74.7%. HAART regimens which include protease inhibitors (PI) (odds ratio [OR]: 1.22; confidence interval at 95% [CI 95%]: 1.11-1.33) and to be older than 40 years (OR: 1.17; CI 95%: 1.05-1.28) were associated with dyslipidemia, adjusted by viral load, CD4 lymphocyte level and gender. In conclusion, dyslipidemia was very common in our sample and was mainly associated with the use of PI. It is necessary to promote the dyslipidemia control as part of the comprehensive care of the patient with HIV.
El objetivo del estudio fue determinar la frecuencia y características de la dislipidemia en pacientes con VIH en terapia antirretroviral de gran actividad (TARGA) en un hospital público peruano. Se realizó un estudio transversal en pacientes que tuvieran un perfil lipídico completo luego de recibir al menos seis meses de TARGA. La dislipidemia se definió según los criterios NCEP-ATP III. Se revisaron 2975 historias clínicas, 538 (18.1%) fueron incluidas en el análisis. La frecuencia de dislipidemia fue 74.7%. Los esquemas de TARGA que incluían inhibidores de la proteasa (IP) (OR 1.22; IC95% 1,11-1,34) y la edad mayor de 40 años (OR 1.17; IC95% 1,06-1,29) mostraron asociación con dislipidemia, ajustado por carga viral, nivel de células CD4 y sexo. En conclusión, la dislipidemia fue muy frecuente en la muestra estudiada y estuvo asociada principalmente al uso de IP. Es necesario promover el control de la dislipidemia como parte de la atención integral del paciente con infección por VIH.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Dislipidemias/induzido quimicamente , Dislipidemias/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Adulto JovemRESUMO
There is little information on the presence of the Mycobacterium avium-Intracellulare (MAC) complex in Peru. Five cases of MAC infection are described in patients with HIV/AIDS at the National Hospital Dos de Mayo, Lima - Peru. The patients presented, mainly, persistent fever, chronic diarrhea, consumptive syndrome, pancytopenia and citofagocitosis. In all of them, resistant acid-alcohol bacilli were identified in feces, so they received antituberculous treatment. The culture of feces was negative for Mycobacterium tuberculosis and, later, in all cases MAC was identified using a molecular test (genotype) in the culture of feces. Three patients received treatment for MAC right after identification; however, they all died. Before presentations similar to the reported, we suggest the use of higher performance methods (blood culture, myeloculture, molecular tests), as well as early associating drugs with activity for MAC to antitubercular scheme with the intention of improving the prognosis of this group of patients.
Existe poca información sobre la presencia del complejo Mycobacterium avium-intracellulare (MAC) en el Perú. Se describen cinco casos de infección por MAC en pacientes con VIH/SIDA del Hospital Nacional Dos de Mayo, Lima-Perú. Los pacientes presentaron, principalmente, fiebre persistente, diarrea crónica, síndrome consuntivo, pancitopenia y citofagocitosis. En todos ellos se identificó bacilos acido-alcohol resistentes en heces, por lo que recibieron tratamiento antituberculoso. El cultivo de heces fue negativo para Mycobacterium tuberculosis y, posteriormente, en todos se identificó a MAC mediante una prueba molecular (Genotype) en el cultivo de heces. Tres pacientes recibieron tratamiento para MAC luego de la identificación; sin embargo, todos fallecieron. Ante presentaciones similares a lo reportado, se sugiere el uso de métodos de mayor rendimiento (hemocultivo, mielocultivo, pruebas moleculares), así como asociar tempranamente drogas con actividad para MAC al esquema antituberculoso con la intención de mejorar el pronóstico de este grupo de pacientes.
Assuntos
Infecções por HIV/complicações , Infecção por Mycobacterium avium-intracellulare/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Feminino , Hospitais , Humanos , Masculino , Peru , Adulto JovemRESUMO
RESUMEN Existe poca información sobre la presencia del complejo Mycobacterium avium-intracellulare (MAC) en el Perú. Se describen cinco casos de infección por MAC en pacientes con VIH/SIDA del Hospital Nacional Dos de Mayo, Lima-Perú. Los pacientes presentaron, principalmente, fiebre persistente, diarrea crónica, síndrome consuntivo, pancitopenia y citofagocitosis. En todos ellos se identificó bacilos acido-alcohol resistentes en heces, por lo que recibieron tratamiento antituberculoso. El cultivo de heces fue negativo para Mycobacterium tuberculosis y, posteriormente, en todos se identificó a MAC mediante una prueba molecular (Genotype) en el cultivo de heces. Tres pacientes recibieron tratamiento para MAC luego de la identificación; sin embargo, todos fallecieron. Ante presentaciones similares a lo reportado, se sugiere el uso de métodos de mayor rendimiento (hemocultivo, mielocultivo, pruebas moleculares), así como asociar tempranamente drogas con actividad para MAC al esquema antituberculoso con la intención de mejorar el pronóstico de este grupo de pacientes.
ABSTRACT There is little information on the presence of the Mycobacterium avium-Intracellulare (MAC) complex in Peru. Five cases of MAC infection are described in patients with HIV/AIDS at the National Hospital Dos de Mayo, Lima - Peru. The patients presented, mainly, persistent fever, chronic diarrhea, consumptive syndrome, pancytopenia and citofagocitosis. In all of them, resistant acid-alcohol bacilli were identified in feces, so they received antituberculous treatment. The culture of feces was negative for Mycobacterium tuberculosis and, later, in all cases MAC was identified using a molecular test (genotype) in the culture of feces. Three patients received treatment for MAC right after identification; however, they all died. Before presentations similar to the reported, we suggest the use of higher performance methods (blood culture, myeloculture, molecular tests), as well as early associating drugs with activity for MAC to antitubercular scheme with the intention of improving the prognosis of this group of patients.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Infecção por Mycobacterium avium-intracellulare/complicações , Infecções por HIV/complicações , Peru , Síndrome da Imunodeficiência Adquirida/complicações , HospitaisRESUMO
El objetivo del estudio fue determinar la frecuencia y características de la dislipidemia en pacientes con VIH en terapia antirretroviral de gran actividad (TARGA) en un hospital público peruano. Se realizó un estudio transversal en pacientes que tuvieran un perfil lipídico completo luego de recibir al menos seis meses de TARGA. La dislipidemia se definió según los criterios NCEP-ATP III. Se revisaron 2975 historias clínicas, 538 (18.1%) fueron incluidas en el análisis. La frecuencia de dislipidemia fue 74.7%. Los esquemas de TARGA que incluían inhibidores de la proteasa (IP) (OR 1.22; IC95% 1,11-1,34) y la edad mayor de 40 años (OR 1.17; IC95% 1,06-1,29) mostraron asociación con dislipidemia, ajustado por carga viral, nivel de células CD4 y sexo. En conclusión, la dislipidemia fue muy frecuente en la muestra estudiada y estuvo asociada principalmente al uso de IP. Es necesario promover el control de la dislipidemia como parte de la atención integral del paciente con infección por VIH.
The objective of the study was to determine the frequency and characteristics of dyslipidemia in patients with HIV in highly active antiretroviral therapy (HAART) in a Peruvian public hospital. A cross-sectional study was carried out in patients with complete lipid profile after receiving at least six months of HAART. Dyslipidemia was defined according to the criteria of the NCEP-ATP III. We reviewed 2 975 clinical histories, and included 538 (18.1%) in the analysis. The frequency of dyslipidemia was 74.7%. HAART regimens which include protease inhibitors (PI) (odds ratio [OR]: 1.22; confidence interval at 95% [CI 95%]: 1.11-1.33) and to be older than 40 years (OR: 1.17; CI 95%: 1.05-1.28) were associated with dyslipidemia, adjusted by viral load, CD4 lymphocyte level and gender. In conclusion, dyslipidemia was very common in our sample and was mainly associated with the use of PI. It is necessary to promote the dyslipidemia control as part of the comprehensive care of the patient with HIV.
