The effect of limited healthcare access on poor outcomes among hospitalized COVID-19 patients in Honduras: A single center cohort study.

Background: The COVID-19 pandemic has had a severe impact on the Latin American subcontinent, particularly in areas with limited hospital resources and a restricted Intensive Care Unit (ICU) capacity. This study aimed to provide a comprehensive description of the clinical characteristics, outcomes, and factors associated with survival of COVID-19 hospitalized patients in Honduras. Research question: What were the characteristics and outcomes of COVID-19 patients in a large referral center in Honduras? Study design and methods: This study employed a retrospective cohort design conducted in a single center in San Pedro Sula, Honduras, between October 2020 to March 2021. All hospitalized cases of confirmed COVID-19 during this timeframe were included in the analysis. Univariable and multivariable survival analysis were performed using Kaplan-Meier curves and Cox proportional hazards model aiming to identify factors associated with decreased 30 day in-hospital survival, using a priori-selected factors. Results: A total of 929 confirmed cases were identified in this cohort, with males accounting for 55.4 % of cases. The case fatality rate among the hospitalized patients was found to be 50.1 % corresponding to 466 deaths. Patients with comorbidities such as hypertension, diabetes, obesity, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease had a higher likelihood of mortality. Additionally, non-survivors had a significantly longer time from illness onset to hospital admission compared to survivors (8.2 days vs 4.7 days). Among the cohort, 306 patients (32.9 %) met criteria for ICU admission. However, due to limited capacity, only 60 patients (19·6 %) were admitted to the ICU. Importantly, patients that were unable to receive level-appropriate care had lower likelihood of survival compared to those who received level-appropriate care (hazard ratio: 1.84). Interpretation: This study represents, the largest investigation of in-hospital COVID-19 cases in Honduras and Central America. The findings highlight a substantial case fatality rate among hospitalized patients. In this study, patients who couldn't receive level-appropriate care (ICU admission) had a significantly lower likelihood of survival when compared to those who did. These results underscore the significant impact of healthcare access during the pandemic, particularly in low- and middle-income countries.

[Abdominal manipulation and other cultural risk factors associated with complication of acute appendicitis in pediatric patients]. / Manipulación abdominal y otros factores de riesgo culturales asociados a complicación de apendicitis aguda en pacientes pediátricos.

In children, acute appendicitis (AA) is usually mistaken for empacho, which, according to popular belief, is caused by the ingestion of undercooked or cold food causing gastrointestinal symptoms. The empirical treatment is abdominal manipulation, consisting of massages with different maneuvers on the abdominal wall, accompanied by home remedies. The effect of these therapies in the presence of AA is unknown. OBJECTIVE: To determine the association between abdominal manipulation and complicated AA in pediatric patients. PATIENTS AND METHOD: Case-control study in a pediatric population under 18 years of age, with acute abdomen symptoms, who underwent surgery for AA, in a tertiary health institution in Honduras. Cases were defined as patients with complicated AA and controls as those with simple AA. A binary logistic regression model was used to determine the risk factors associated with complications of AA. RESULTS: Sixty-two pediatric patients were analyzed (31 cases and 31 controls) with a median age of 11 years. 58.1% were from an urban area. 77.4% of the cases and 9.7% of controls had a history of abdominal manipulation. The most frequent initial symptom was abdominal pain. In the univariate analysis, male sex, prolonged evolution time, use of home remedies, leukocytosis > 20,000/mm3, and abdominal manipulation were risk factors for complicated AA. In the multivariate model, abdominal manipulation was the main risk factor (OR 15.94 [3.4074.59]). CONCLUSION: Cultural beliefs such as empacho and its respective treatments such as abdominal manipulation and use of home remedies are risk factors for the complication of an established AA case, as well as contributing to the delay in diagnosis.

Encefalitis aguda con síndrome cerebeloso secundario a neuroborreliosis

La enfermedad de Lyme es la infección transmitida por garrapatas más común en Norteamérica y Europa. Sin embargo, en América Latina se han reportado pocos datos. Borrelia burgdorferi es capaz de invadir el sistema nervioso central causando la neuroborreliosis de Lyme. Se comunica el caso de una mujer joven con encefalitis y síndrome cerebeloso, una presentación poco frecuente, que se manifestó con cefalea, marcha atáxica, nistagmo y ptosis palpebral. Se realizó el diagnóstico con serología positiva por Western blot para Borrelia burgdorferi en suero. Recibió tratamiento con mejoría clínica. El diagnóstico de neuroborreliosis es difícil, ya que no existen hallazgos neurológicos o de imagen específicos. Se recomienda tener un mayor nivel de vigilancia epidemiológica en Latinoamérica, así como los antecedentes recreativos o viajes, que deben incluirse en la historia clínica para mejorar la aproximación diagnóstica.

Lyme disease is the most common tick-borne disease in North America and Europe. However, in Latin America, few data have been reported. Borrelia burgdorferi is capable of invading the central nervous system causing Lyme neuroborreliosis. This is a case report of a female with encephalitis and cerebellar syndrome, a rare manifestation, presented with generalized headache ataxic gait, nystagmus and palpebral ptosis. Serologic diagnosis was made for Borrelia burgdorferi and treatment was initiated with clinical improvement. Neuroborreliosis is a very difficult diagnosis, since there are no neurologic or imaging findings specific. It is recommended to physicians to have an enhanced level of surveillance in Latin America, as well as recreational/travel history of the patient, which should be included in the clinical record to improve the diagnostic approach.

Intraumbilical versus intramuscular oxytocin in the management of the third stage of labor.

OBJECTIVE: To compare the effect of intraumbilical vein oxytocin injection with standard management in reducing blood loss during the third and fourth stages of labor. Acute complications threaten the mother's life during the third and fourth stages of labor. The most common complication is postpartum hemorrhage, which remains a leading cause of maternal mortality, particularly in developing countries. METHODS: A randomized controlled trial was conducted in the Gynecology and Obstetrics Department of Leonardo Martínez Valenzuela Hospital from January to June 2021. A probabilistic sample was used: 332 pregnant patients were enrolled in the study and randomized into the case (166 patients) and control (166 patients) groups. The volume of blood lost was compared between the groups. RESULTS: The median estimated blood loss was 120 mL (interquartile range [IQR], 80-218.75 mL). There was a statistically significant difference between the groups, showing less estimated blood loss in the international unit group with a median of 80 mL (IQR, 60-100 mL) (P<0.001), and 200 mL (IQR, 143.75-300 mL) in the intramuscular (IM) group, highlighting that 66.8% of the IM group had an estimated blood loss >251 mL. CONCLUSION: Any reduction in bleeding during labor is clinically relevant because it improves patient prognosis. The use of intraumbilical oxytocin injection with active management of the third stage of labor significantly reduced postpartum blood loss and the duration of the third stage compared with the IM group.

Clinical features, coagulation and inflammatory biomarkers associated with poor in-hospital outcomes in a Honduran population with RT-PCR confirmed COVID-19.

Background: SARS-COV-2, in most cases, only generates a mild acute respiratory disease. However, patients with severe disease show an exaggerated response of the immune system, creating a pro-inflammatory state, which could cause abnormalities in the coagulation system that increases mortality. Latin American countries, specially those with limited resources, have few studies about clinical features, coagulation and inflammatory biomarkers that could be useful at admission to assess poor outcomes. Objective: The objective of this study is to describe the clinical features, coagulation, and inflammatory biomarkers, and identify risk factors at admission that are associated poor outcomes in Honduran population. Methods: A cohort study was conducted. 210 patients were included, which 105 died during hospitalization due to COVID-19 and 105 were discharged alive, between September 2020 and January 2021. Clinical and laboratorial data was retrospectively collected. Results: 57,6% of the population were male. The median age was 58 years. The median time between symptom onset and hospital admission was 6 days. D-dimer median was higher in the dead group compared with the alive group. Poor prognosis factors in the Cox multivariable model were male gender, age, symptom's duration, obesity and an elevated d dimer at admission. Conclusion: In low-middle income countries, the assessment of these clinical and laboratory tools, especially in those with risk factors for prothrombotic states, could help clinicians to correctly stratify disease prognosis, establish a baseline to evaluate further evolution, and also predict outcomes, thus improving patient management.

Complicaciones e impacto psicológico secundario a remodelación de contorno corporal en pacientes con pérdida masiva de peso: serie de casos / Complications and psychological impact secondary to body contouring in patients with massive weight loss: case series

Introducción y objetivo: La alta prevalencia de obesidad ha hecho que los métodos de pérdida de peso sean más frecuentes, aumentando los pacientes con pérdida masiva de peso. Esto genera excedentes cutáneos y pliegues redundantes que provocan un impacto negativo en la calidad de vida e imagen corporal.El objetivo de este estudio es describir las características sociodemográficas, procedimientos quirúrgicos, complicaciones e impacto en la calidad de vida en pacientes con pérdida masiva de peso sometidos a cirugía de contorno corporal, con el fin de analizar el impacto psicológico en la vida del paciente tras la intervención quirúrgica.Material y método.Estudio observacional, descriptivo, prospectivo, tipo serie de casos, que analiza 8 pacientes adultos sometidos a cirugía de contorno corporal tras pérdida masiva de peso. Empleamos estadística descriptiva, obtuvimos frecuencias y porcentajes de las variables categóricas y calculo de la mediana y rangos intercuartílicos de las variables cuantitativas.Resultados.La mediana de edad fue de 52 años. La mediana de la pérdida de peso fue de 48.70 kg. Las complicaciones más frecuentes fueron dehiscencia de herida quirúrgica (50%), seroma (25%) e hipertrofia de cicatriz (25%). Inicialmente, clasificamos los pacientes en un 50% con depresión ligera/menor; tras la intervención quirúrgica el 50% no estaba deprimido, el 37.5% tenía depresión ligera/menor, y el 12.5% depresión moderada. El 100% tuvo una disminución de puntuación suficiente para cambiar de categoría.Conclusiones.En nuestra opinión, la cirugía de contorno corporal mejora considerablemente el estado psicológico del paciente, su estilo de vida y autoestima al tener una mejor percepción corporal, aportando beneficios superiores a las complicaciones que se pudieran presentar durante el proceso quirúrgico. (AU)

Background and objective: The high prevalence of obesity has made weight loss methods more frequent, increasing the number of patients with massive weight loss. This generates skin excess and redundant folds generating a negative impact on quality of life and body image.The aim of this study is to describe the sociodemographic characteristics, surgical procedures, complications and the impact on quality of life in patients with massive weight loss who underwent body contouring surgery, in order to provide the psychological impact on the patient with a considerable weight loss.Methods.Observational, descriptive, prospective, case series study analyzing 8 adult patients who underwent body contouring surgery after a massive weight loss. Descriptive statistics were used, frequencies and percentages were obtained for categorical variables, and median and interquartile ranges were calculated for quantitative variables.Results.The median age was 52 years. The median weight loss was 48.70 kg. The most frequent complications were surgical wound dehiscence (50%), seroma (25%) and scar hypertrophy (25%). Fifty percent were not depressed, 37.5% were mildly/minorly depressed, and 12.5% were moderately depressed. Seventy-fve percent of patients had a decrease in score suficient to change category.Conclusions.In our opinion, body contouring surgery considerably improves patient's psychological state, lifestyle and self-esteem by having a better body perception, being the benefts superior to the complications that occur during the surgical process. (AU)

Complicated acute appendicitis in pediatric patients with "empacho" and abdominal manipulation history: Case series. / Apendicitis aguda complicada en pacientes pediátricos con antecedentes de "empacho" y manipulación abdominal: Serie de casos.

INTRODUCTION: According to Latin American popular culture, empacho is a gastrointestinal disease caused by ex cessive intake of cold or under-cooked food. Abdominal manipulation or sobada is one of the popular treatments used for empacho and consists of an abdominal massage, where the skin is rubbed and stretched, applying pressure on the abdomen. OBJECTIVES: To characterize clinical evolution and complications secondary to diagnostic delay in pediatric patients with acute appendicitis, with history of empacho and abdominal manipulation. PATIENTS AND METHOD: Descriptive, observational, How to cite this article: Andes pediatr. 2021;92(1):86-92. DOI: 10.32641/andespediatr.v92i1.3352 prospective study of pediatric patients with complicated acute appendicitis and history of abdominal manipulation, identified in the pediatric surgery room between November 2019 and June 2020 at the Mario Catarino Rivas Hospital. Descriptive statistics were used for analysis. RESULTS: 10 patients were studied, aged ranging from 6 to 16 years (median age 14 years). Half of them were from rural areas. The main symptoms that appeared before abdominal manipulation were vomiting, nausea, and loss of appetite, followed by sudden diarrhea or constipation, and increased pain intensity. Complications were gastrointestinal perforation (5/10), appendicular mass (3/10), intra-abdominal abscess (3/10), and gangrenous appendicitis (1/10). The median time between initial symptom and hospitalization was 60 hours [IQR, 33.0 - 72.0]. CONCLUSION: This study describes the influence of the empacho and its respective treatment on clinical deterioration due to the delay in diagnosis and treatment of acute appendicitis, resulting in different complications.

Enfermedad de Hirschsprung y apendicitis en paciente pediátrico: reporte de caso / Hirschprungs diseases and appendicitis in pediatric patient: case report

La enfermedad de Hirschsprung es una malformación del sistema nervioso entérico, caracterizada por falta de células ganglionares en plexo submucoso y mientérico en pared distal del colon. En el 80% solo existe afectación del recto-sigma, sin embargo, pueden encontrarse casos de aganglionosis total. Reporte de Caso: Se presenta pre-escolar masculino de 4 años de edad, procedente de La Iguala, Lempira, Honduras, con historia de constipación y distensión abdominal de dos años de evolución, que ha empeorado progresivamente, y se atenuaba con el uso de enemas cada dos días para poder defecar. En mayo de 2016 llega al Hospital Mario Catarino Rivas, donde se le realizó una laparotomía exploratoria de emergencia debido a la presencia de deterioro clínico por constipación y distensión abdominal, acompañada de vómitos con restos alimenticios y fiebre alta de una semana de evolución. En dicha operación se realizó colectomía parcial izquierda, además se realizó una colostomía terapéutica y se diagnósticó enfermedad de Hirs-chsprung mediante biopsia, además del hallazgo incidental de apendicitis, se realizó apendicectomía obteniendo en general, una evolución satisfactoria.El estudio histopatológico de la biopsia del recto es el estándar de oro para realizar el diagnóstico. La ausencia de células ganglionares en el plexo submucoso con latinción hematoxilina y eosina establece el diagnóstico. El tratamiento de la enfermedad de Hirschsprung es de tipo quirúrgico y se busca la eliminación del segmento colónico afectado, de manera que se pueda lograr una anastomosis del colon proximal y distal al área agangliónica...(AU)

Carcinoma de plexo coroideo en paciente pediátrico: reporte de caso / Choroid plexus carcinoma in pediatric pacient: case report

El carcinoma de plexo coroideo se considera dentro de los tumores del cerebro como uno de los más infrecuentes, presentándose principalmente en la población pediátrica con mayor incidencia en hombres. Las principales manifestaciones clínicas son secundarias a la obstrucción del flujo de líquido cefalorraquídeo. Dentro de los estudios de imagen que se pueden emplear para realizar el diagnóstico están la tomografía computarizada y la resonancia magnética sin embargo el diagnóstico definitivo es el estudio anatomopatológico. Presentamos el caso clínico de un niño de 13 años de edad que acudió a la emergencia de pediatría del Hospital Mario Catarino Rivas por cefalea de dos meses de evolución que posteriormente presentó alteración de la marcha y hemiparesia derecha. El principal objetivo de tratamiento es la resección total sin embargo no se logra en todos los casos. Se ha propuesto el uso de quimioterapia adyuvante con o sin radiación, sin embargo, aún no se ha estandarizado este enfoque...