Alteraciones somatométricas y menor puntaje aPGar en recién nacidos indígenas / Somatometric alterations and lower APGAR score in indigenous newborns

Introducción: la población indígena es vulnerable y poco se conoce sobre sus indicadores somatométricos y APGAR al nacimiento. Objetivo: explorar la asociación de la condición de recién nacido indígena (RNI) sobre parámetros somatométricos y APGAR al nacimiento. Métodos: estudio transversal exploratorio que empleó el registro de recién nacidos (RN) de una clínica privada. La condición de RNI se determinó por la condición indígena materna. Se consideraron la puntuación APGAR al primer minuto y los indicadores nutricionales derivados del peso, la talla y los perímetros. El análisis estadístico empleó regresiones logísticas. Resultados: el análisis exploratorio involucró a 7413 RN (1,8 % de RNI). El 52 % de los RN eran de sexo masculino y el 8,1 % fueron pretérmino (< 37 semanas). Los RNI, respecto a los RN no indígenas, presentaron mayor riesgo de desnutrición (8 % vs. 6,3 %; p < 0,001), mayor exceso de peso (7,3 % vs. 1,8 %; p < 0,001), menor perímetro cefálico (33,6 cm vs. 34,1 cm; p = 0,017), menor perímetro abdominal (30,9 cm vs. 31,5 cm; p = 0,011) y bajo puntaje APGAR < 7 (8,7 % vs. 1,2 %). La condición de indígena se asoció de manera independiente con el bajo peso (< 2500 g) al nacimiento (OR: 0,4; IC 95 %: 0,2; 0,9), perímetro cefálico en exceso (OR: 2,7; IC 95 %: 1,5; 4,7) y puntaje de APGAR < 7 puntos (OR: 8,3; IC 95 %: 4,2; 16,5). Conclusiones: la condición de indígena se asocia con indicadores que impactan negativamente en la salud de los recién nacidos, como son el perímetro cefálico y el bajo desempeño en la escala APGAR. Estos resultados deben tomarse como un llamado para mejorar la atención prenatal de la población indígena.(AU)

Introduction: the indigenous population is vulnerable and there is limited understanding of their somatometric indicators and APGAR score at birth. Aim: the objective of the study was to explore the association of the condition of indigenous newborn (INB) on somatometric parameters and APGAR score at birth. Methods: this study employed an exploratory cross-sectional design, utilizing the registry of newborns (NB) from a private clinic. The APGAR score at one minute after birth, as well as nutritional indicators derived from measurements of weight, height, and perimeters, were taken into consideration. The statistical analysis involved the use of logistic regressions. Results: the analysis included 7413 NB (1.8 % INB), 52 % were male and 8.1 % were born preterm (gestational age < 37 weeks). In comparison to non-indigenous NB, the INB group showed a higher risk of malnutrition (8 % vs. 6.3 %; p < 0.001), a greater prevalence of excess weight (7.3 % vs. 1.8 %; p < 0.001), smaller head circumference (33.6 cm vs. 34.1 cm; p = 0.017), smaller abdominal circumference (30.9 cm vs. 31.5 cm; p = 0.011), and a higher occurrence of low APGAR scores (< 7) (8.7 % vs. 1.2 %; p < 0.001). Furthermore, the indigenous condition was independently associated with low birth weight (< 2.500 g) (OR, 0.4; 95 % CI, 0.2; 0.9), excess head circumference (OR, 2.7; 95 % CI, 1.5; 4.7), and APGAR score < 7 points (OR, 8.3; 95 % CI, 4.2; 16.5). Conclusions: the indigenous condition was associated with factors that have adverse effects on the health of NB, including reduced head circumference and suboptimal performance on the APGAR scale. These results emphasize the importance of improving access to and quality of prenatal healthcare services for indigenous communities.(AU)

[Somatometric alterations and lower APGAR score in indigenous newborns]. / Alteraciones somatométricas y menor puntaje APGAR en recién nacidos indígenas.

INTRODUCTION: the indigenous population is vulnerable and there is limited understanding of their somatometric indicators and APGAR score at birth. AIM: the objective of the study was to explore the association of the condition of indigenous newborn (INB) on somatometric parameters and APGAR score at birth. METHODS: this study employed an exploratory cross-sectional design, utilizing the registry of newborns (NB) from a private clinic. The APGAR score at one minute after birth, as well as nutritional indicators derived from measurements of weight, height, and perimeters, were taken into consideration. The statistical analysis involved the use of logistic regressions. RESULTS: the analysis included 7413 NB (1.8 % INB), 52 % were male and 8.1 % were born preterm (gestational age < 37 weeks). In comparison to non-indigenous NB, the INB group showed a higher risk of malnutrition (8 % vs. 6.3 %; p < 0.001), a greater prevalence of excess weight (7.3 % vs. 1.8 %; p < 0.001), smaller head circumference (33.6 cm vs. 34.1 cm; p = 0.017), smaller abdominal circumference (30.9 cm vs. 31.5 cm; p = 0.011), and a higher occurrence of low APGAR scores (< 7) (8.7 % vs. 1.2 %; p < 0.001). Furthermore, the indigenous condition was independently associated with low birth weight (< 2.500 g) (OR, 0.4; 95 % CI, 0.2; 0.9), excess head circumference (OR, 2.7; 95 % CI, 1.5; 4.7), and APGAR score < 7 points (OR, 8.3; 95 % CI, 4.2; 16.5). CONCLUSIONS: the indigenous condition was associated with factors that have adverse effects on the health of NB, including reduced head circumference and suboptimal performance on the APGAR scale. These results emphasize the importance of improving access to and quality of prenatal healthcare services for indigenous communities.

Bilateral visual disturbances caused by a glomus vagale: illustrative case.

BACKGROUND: A glomus vagale tumor is an infrequent paraganglioma primarily characterized by auditory symptoms, cranial nerve involvement, or autonomic symptoms. However, visual involvement is not commonly observed, and to date, no cases have been reported in the literature. OBSERVATIONS: The case involves a 62-year-old female patient with a history of right carotid body tumor resection. She presented to the emergency department with a sudden decrease in visual acuity and bitemporal hemianopsia, accompanied by a left parietal headache. Initial brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, which was completely resected. However, postoperatively, the patient developed left amaurosis. Subsequent brain MRI showed the presence of hemostatic material mixed with blood in the sellar region, causing displacement of the optic chiasm. A repeat intervention was performed, identifying bleeding from both cavernous sinuses. Head and neck angiography demonstrated a right glomus vagale tumor with abundant blood drainage into the right cavernous sinus. Embolization of the glomus vagale tumor was performed, resulting in no further bleeding and improvement of symptoms. LESSONS: The aim of this case report is to describe a rare occurrence of bilateral visual disturbances caused by bleeding in both cavernous sinuses due to venous hypertension caused by a right glomus vagale tumor.

The Comorbidities, Radiographic Findings, Age, and Lymphopenia (CORAL) Tool: A Diagnostic Ally for Emergency Physicians Created for the COVID-19 Crisis and Beyond.

BACKGROUND: This study aimed to develop a novel clinical approach to predict intensive care unit (ICU) admission and mortality among coronavirus disease 2019 (COVID-19) patients in the emergency department (ED). METHODS: A retrospective cohort study was conducted including adults ≥ 18 years diagnosed with COVID-19 in the emergency department and admitted to the ICU between March and July 2020 in an academic hospital. The outcome variables were mortality and ICU admission. Additional variables that were collected included sex, age, comorbidities, symptom phenotype, and laboratory (lymphopenia) and imaging findings. A logistic regression model was used to construct and validate the risk models. RESULTS: A total of 808 patients were included in the study; 61.9% were men. The mean age was 57.8 ± 15.9 years, and high blood pressure (HBP) was the most prevalent comorbidity (31.8%). Seventy-six (9.4%) patients were admitted to the ICU. Age ≥ 60 years, chronic obstructive pulmonary disease (COPD), lymphopenia, and imaging findings correlated with mortality. Age ≥ 60 years, lymphopenia (<1,000 cells per microliter), and hypothyroidism correlated with ICU admission. These variables were incorporated into a scoring system (Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool) to predict mortality and ICU admission. CONCLUSIONS: Our Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool is a practical tool for different clinical settings independent of access to advanced medical resources or technologies. CORAL is suitable for emergency physicians in low- and middle-income countries.

Dissecting a radiculomedullary artery as an infrequent cause of low back pain: illustrative case.

BACKGROUND: There is currently no case described in the literature of epidural hematoma associated with subarachnoid hemorrhage due to dissection of a spontaneous radiculomedullary artery at the lumbar level and therefore its incidence and prevalence are not known. However, its etiology is thought to be similar and may not be diagnosed given its nonspecific symptomatology. OBSERVATIONS: The authors present the case of an adult patient who consulted the emergency department for 2 weeks of low back pain. On physical examination there were negative signs of radiculopathy without neurological focalization. The patient was evaluated by neurosurgery via thoracic and lumbosacral spine magnetic resonance imaging, with findings of epidural hematoma associated with subarachnoid hemorrhage in the lumbosacral region. After that, panangiography was done. In the study, it was possible to visualize a dissection of the radicular artery at the L2 level. The patient was not a candidate for surgical management and continued with medical pain management. The patient has a good clinical evolution and was discharged. LESSONS: The aim of the present case is to describe a unique case of radiculomedullary artery dissection as a cause of spontaneous epidural hematoma associated with a subarachnoid hemorrhage in the lumbar region.