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OBJECTIVE: To compare the qSOFA, SOFA and SIRS scales to assess the risk of sepsis and hospital admission in patients with suspected infection and to identify the risk of sepsis with the same scales by diagnostic groups. MATERIALS AND METHODS: Comparative, cross-sectional, retrolective study of the qSOFA and SIRS scales, done from 2016 to 2017 in a fourth-level institution in Colombia, to assess the risk of sepsis and hospital admission in patients with suspected infection. Measures of central tendency (mean, median, mode) and measures of dispersion (standard deviation) were obtained for quantitative variables and relative frequency for qualitative variables. RESULTS: We studied 366 patients with a mean age of 58.33 ± 20.9 years, with limits of 18 and 101 years, mode of 77 and median of 60 years. When applying the qSOFA scale, 78.1% had a score of 0, 17.5% a score of one point and 4.3% a score greater than 2. As for the SIRS scale, 38% had a score of 0, 36.3% had one point and 25% obtained a score greater than 2. CONCLUSIONS: In the emergency department, most of the population studied was at low risk of sepsis according to qSOFA and SIRS, with adequate correlation between them. Regarding the higher risk of sepsis, according to SIRS, there was a higher percentage of the population compared to qSOFA. [ABSTRACT FROM AUTHOR]

Pediatric sepsis continues to be one of the main causes of mortality in low and middle-income countries, its early recognition in emergencies requires the use of criteria that allow us to predict the severity of the patient. Objective: our study aims to compare the SIRS criteria and qSOFA regarding its discriminatory capacity in mortality in children with sepsis. Methods: a prospective multicenter study was carried out in emergency services enrolling children with suspected sepsis subsequently admitted to the PICU, in which the scores in qSOFA and SIRS were evaluated comparing them with the results at hospital discharge. Results: 64 patients were enrolled, admitted in emergency in Sepsis (19%), Septic Shock (20.6%) and with Multiple Organ Dysfunction (60.4%) stage, with a mortality respectively of 9.5% and 14.3% and 76.2%; germ could be rescued in 33.9% of the cases; Evaluating the SIRS criteria, we see that the absence of them is associated with lower mortality (p = 0.044; OR 0.618: 95% CI 0.502-0.761); otherwise, 2 or more qSOFA criteria are associated with higher mortality (p = 0.047; OR 3.52: 95% CI 1.090-11.371). Conclusion: both criteria used to define sepsis in pediatrics demonstrated their usefulness, the use of the qSOFA score given its close relationship with mortality can be used to anticipate life-threatening organ alterations. [ABSTRACT FROM AUTHOR]

Introduction: Postimplantation syndrome is a common disorder, produced in the immediate postoperative period after endovascular treatment of aortic disease, characterized by anorexia, thoracic or low back pain, leukocytosis, fever and elevation of C-reactive protein, occasionally associated with decreased platelet count or coagulation disorders. Aim: To assess postimplantation syndrome after endovascular aortic repair. Material and Methods: This is an observational, and descriptive study; we analyze the presence of postimplantation syndrome, in 112 successive endovascular repairs of the thoracic and abdominal aorta, over a period of 10 years (2009 to 2019), in the Hospital Dr. Eduardo Pereira in Valparaíso, Chile. Results: 112 endovascular repairs were performed, 81 cases (72.32%) corresponding to EVAR and 31 cases (27.68%) to TEVAR, incidence of post-implantation syndrome was 17.85%. Associated risk factors were age ≤ 75 years, use of polyester stent grafts, aortic covered ≥ 20 cm, surgical time ≥ 180 min, (p < 0.05). As a consequence, in this group of patients, there were associated with greater readmission rates, hospital stay rates and cardiovascular morbidity (p < 0.05). Discussion: The post-implantation syndrome leads to an increase in cardiovascuar morbidy hospital stay rates and a slower postoperative recovery, with the corresponding associated risks and costs, therefore it could be considered a complication of endovascular aortic repair. Conclusion: The inflammatory response after endovascular repair of the aorta, may be intense in some patients, the group of patients who develop this syndrome deserve close monitoring, with emphasis during the first month after surgery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prediction of mortality using the qSOFA scale and other clinical indicators in patients with sepsis, in the intensive care unit in a health institution of the public network of the City of Barranquilla, between July 2020 and February 2021. Methods: An analytical, longitudinal, prospective study was conducted. With the information obtained, the database was performed in Excel, and then, an univariate and multivariate analysis to describe the best predictor of mortality in sepsis. Results: Of 101 cases, 82% (n=83) had septic shock, the most common presentation in males with 61% (n=64), with a greater frequency of socioeconomic stratum 1, most of them were sepsis acquired in community 81% (n=85), with a Charlson comorbidity index of 3.4 ± 3.0. Serial measurements of lactate and CRP had no statistically significant relationship with mortality. The value of q-SOFA presented a statistically significant association with mortality (p < 0.05), high q-SOFA values have twice the risk of death (OR = 2.16; 95% CI = 1.08 – 4.33). Sensitivity of 68.6% and specificity of 48.4%, PPV of 76% and VPN of 34.37% Conclusion: The qSOFA score was found to be the best predictor of mortality in sepsis compared to SIRS, SOFA, PCR and Lactate. [ABSTRACT FROM AUTHOR]

Sepsis constitutes a frequent cause of death, early diagnosis is essential to achieve proper management. Definitions and consensus have undergone modifications over time, so the surgical and medical team must be aware of these changes and must be constantly updated. The consensus of Sepsis-3 proposes the use of qSOFA and SOFA in order to improve the specificity of the recognition of patients with greater severity; however, this is achieved at the expense of lower sensitivity, so that the standard SIRS criteria should continue to be used when sepsis is suspected. The early identification of patients is very important to optimize the handling of the medical team. Surgical sepsis remains a difficult clinical picture to recognize and manage. It is an emergency that requires initial actions during the first hour of suspicion. By this it is important for the surgeon to know these actions that allow him or her to plan a possible emergency surgery when appropriate with adequate medical support. The objective of this update is for surgeon and medical team to know the changes in sepsis consensus regarding diagnosis and management under a critical view, as well as to know the therapeutic approach of a surgical sepsis to improve the survival of our patients. [ABSTRACT FROM AUTHOR]

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Introduction: The systemic inflammatory response has been described in patients with appendicitis. However, its progression from the onset of symptoms to diagnosis has not been characterized. The purpose of this study was to describe and characterize the systemic inflammatory response to appendicitis. Patients and Methods: A descriptive study was conducted. One-hundred eighty-three patients were studied divided into four groups from onset of symptoms to diagnosis. Primary outcome measure was to determine the systemic inflammatory response to appendicitis according to the established groups of time intervals. Secondary outcome measure was the analysis of C-reactive protein for the same purpose. Results: The systemic inflammatory response variables according to diagnostic intervals showed non-significant differences on white blood cells count. Temperature and heart rate rises constantly after 48 h reaching their peak after 72 h (p = 0.001); the respiratory rate rises after 73 h (p < 0.0001). After 73 h most patients had 3 or 4 systemic inflammatory response criteria (p < 0.0001). C-reactive protein levels rise progressively showing higher levels after 48 hours (p = 0.005). Conclusions: The inflammatory response to appendicitis is progressive, being more marked along the timeline from onset of symptoms to diagnosis. [ABSTRACT FROM AUTHOR]

Neonatal septicemia is a major cause of mortality and morbidity in horses in their first seven days of life and within their pathophysiology. It is important to consider the extrinsic and intrinsic predisposing factors which make foals susceptible to agents of primarily bacterial etiology. However, other types of infectious etiology (viruses and fungi) should be considered too, as well as noninfectious etiologies. The paper mentions a wide variety of mechanisms that produce different injuries that must be addressed with measures of critical neonatal care, so it is imperative for the veterinarian to know the pathogenic mechanisms of the disease, its clinical presentation and anatomo-pathological lesions. Thus, systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and peripheral circulatory collapse or shock are some of the elements defined as the pillars of the pathophysiology of neonatal septicemia, extensively studied in equine medicine. This paper presents a short review of the triggering mechanisms of neonatal septicemia highlighting the importance of epidemiological investigations in Colombia. It shows the need for retrospective and prospective studies and for divulgation of some of the preventive measures of the disease in horses. [ABSTRACT FROM AUTHOR]

Extracorporeal circulation (EC) was initiated 50 years ago for allowing open-heart surgery in order to fix congenital and acquired heart abnormalities in children and adults. The blood pump, based on rolls or centrifugal force impeller, drives blood through a gas exchange membrane, called oxygenator, primed with heparin to interfere formation of blood clots. Complications of cardiac surgery related to EC has been associated to many factors such as immunological system activation due to blood contact with non-endothelial covered surfaces in the EC circuit, oxygen free radical generation stimulated by aortic clamping and reperfusion ischemia, hemolisis due to shear stress on blood cells, microemboli generation eventually passing to peripheral circulation, heparin anticoagulation and problems derived from its neutralization at the end of surgery, hemodilution due to great volume of infused solutions and hemoderivates administration.The surgical trauma and the EC procedure stimulate the hypothalamus-hypophysial-adrenal axis to release vasopressin, catecholamines, cortisol, acute phase proteins, pro- and anti-inflammatory cytokines. Activation of formerly described neurohumoral and cellular mechanisms are known as the systemic inflammatory response syndrome (SIRS). In pediatric patients, 24% may present surgical complications due to EC use for blood perfusion; their risk of hemorrhage is higher because some have preexisting blood coagulation disturbances, particularly the ones with cianogenic heart abnormalities linked to thrombocytopenia, reduction of some coagulation factors and enhanced fibrinolisis. Adults who underwent myocardial revascularization without extracorporeal blood pumping show less mortality and adverse events rate. In cardiac surgery, atrial natriuretic peptide and brain natriuretic peptide, both neurohormones synthetized in heart tissue, have emerged as reliable assays for prediction of immediate and short-term postoperatory cardiovascular complications. [ABSTRACT FROM AUTHOR]

Objective. To study the effect of glutamine supplement in septic children could reduce the frequency of systemic inflammatory response syndrome (SIRS). Material and methods. Comparative clinical study done in septic a Pediatric Intensive Care Unit (PICU) in 15 critical in children with sepsis whom, beside the sepsis treatment, received oral supplements of glutamine and other group of 16 children with sepsis, with similar treatment that not received glutamine. During the treatment in all of them were done periodically leucocytes and platelets counts, and the length to stay on PICU and in the hospital was registrated. Results. There was not statistical differences in the leucocytes and platelets counts, length to stay on PICU and the hospital Conclusion. The use of glutamine supplement in critically ill children with sepsis does not make any difference in the treatment in children. [ABSTRACT FROM AUTHOR]

The systemic inflammatory response syndrome (SIRS) is a pattern of frequent presentation in surgical patients, which may evolve into multi-organ failure with devastating consequences. In this situation, increased production of acute phase reactants, including the C-reactive protein (CRP) is one of the most sensitive markers. Objective: To determine the concentration of CRP as a prognostic factor in patients with severe SIRS in the Surgery setting of the University Hospital Dr. Angel Larralde (HUAL). Patients and Methods: This is a descriptive, longitudinal study that included 50 patients diagnosed with SIRS who were admitted to the Surgery Emergency Room of HUAL during the period December 2007-June 2008. Serum concentrations of CRP were assayed and the APACHE II score estimated at admission time and thereafter 24 and 72 hours of hospitalization. Statistical significance of change was calculated with univariate and inferential statistics; p < 0.05 was considered significant. Data were processed with Statgraphics plus 5.1. Results: It was found statistical significance, at medium to high levels, that as higher the CRP concentration as higher the Apache II score. Patients with higher CRP levels were more susceptible to multi-organ failure and death. Conclusions: The CRP is a reliable biochemical marker whose levels are positively correlated to the severity of SIRS. [ABSTRACT FROM AUTHOR]

INTRODUCCIÓN: Las infecciones no obstétricas en gestantes se exacerban como consecuencia de los cambios fisiológicos del embarazo, siendo estas un factor importante de progresión a sepsis y choque séptico. El Síndrome de Respuesta Inflamatoria Sistémica (SIRS) es una herramienta ampliamente utilizada para pronosticar la severidad en éste grupo de pacientes. Actualmente, se ha propuesto la escala quick Sequential Organ Failure Assessment (qSOFA) para hacer pronóstico de severidad de la infección, sin embargo esta no ha sido enfocada en la población obstétrica. Por lo cual, este estudio evaluó la utilidad de la escala qSOFA y los criterios de SIRS en la predicción de desenlaces adversos en maternas con cuadros infecciosos. MATERIALES Y MÉTODOS: Se realizó un estudio de cohorte prospectivo, tomando como población objeto a todas las pacientes gestantes o puérperas (hasta 42 días pos-parto o post-aborto) hospitalizadas en sala general de la Clínica de Maternidad Rafael Calvo (CMRC) con infección confirmada o sospechada en el período comprendido entre marzo - agosto de 2017. La información se obtuvo mediante entrevista directa a las pacientes junto con la revisión de la historia clínica sistematizada y el seguimiento clínico realizado hasta el alta médica. Todo esto posterior al aval por parte del comité de ética médica de la CMRC y la firma del consentimiento informado por la paciente. El análisis estadístico se realizó con el software STATA 13 y PRISMv.7. RESULTADOS: Se capturaron un total de 269 pacientes y fueron incluidas al estudio 248 pacientes, las cuales cumplían con los criterios de inclusión. 21 pacientes (8,4%) presentaron qSOFA =2 y 91 (36,6%) presentaron SIRS =2. La escala qSOFA mostró ser adecuada para valorar SMO (Severe Maternal Outcome) e ingreso a Unidad de Cuidados Intensivos (UCI) resultando ser estadísticamente significativos (p = 0.003 y 0.001 respectivamente). Las pacientes con SIRS = 2 mostraron más riesgo de ingreso a UCI (p <0.0001) y de parto pretérmino (p= 0.004) que aquellas con SIRS < 2. Se identificó mayor especificidad para qSOFA = 2 a costa de baja sensibilidad, lo contrario ocurrió con SIRS = 2. Cuando se comparó SIRS vs qSOFA en la evaluación de ingreso a UCI, el primero resulto tener mayor discriminación, lo contrario ocurrió al discriminar SMO donde qSOFA tuvo una mayor área bajo la curva (AUC) que SIRS (0.57; IC 95%, 0.47 - 0.66 y 0.52; IC 95%, 0.41 - 0.62 respectivamente). CONCLUSIONES: La escala qSOFA demostró ser adecuada para valorar SMO, mientras que el SIRS predijo mejor que qSOFA el riesgo de ingreso a UCI en pacientes obstétricas. qSOFA = 2 presentó alta especificidad con baja sensibilidad lo cual limita su utilidad como método de detección temprana de resultados adversos obstétricos, dicha escala podría necesitar ajustes al ser aplicada a gestantes. [ABSTRACT FROM AUTHOR]