Search

Resumen: Introducción: la estimación temprana del riesgo en falla cardiaca aguda puede ayudar en la toma de decisiones clínicas. Objetivo: identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con falla cardiaca aguda. Métodos: análisis de una cohorte retrospectiva de pacientes mayores de 18 años ingresados a hospitalización por falla cardiaca aguda en un hospital de tercer nivel, entre los años 2012 y 2016. Resultados: se incluyeron 247 pacientes, con edad promedio de 62,8 años; predominó el sexo masculino con un 60%. El 84% de los pacientes tenía falla cardiaca con fracción de expulsión disminuida (mediana de 25%). La mortalidad intrahospitalaria fue de 9,3% y la acumulada a 30 días y 6 meses posterior al egreso hospitalario fue de 10,9 y 14,1%, respectivamente. Los dos predictores asociados a muerte intrahospitalaria fueron el nitrógeno ureico en sangre (BUN) > 37 mg/dl (OR: 10,8; 95% IC: 4,10-28,8) y la presión arterial sistólica (PAS) ≤ 125 mm Hg (OR: 3,42; 95% IC:1,15-10,0). El modelo de árbol de regresión y clasificación (CART) identificó como el mejor predictor de mortalidad los niveles elevados de BUN (≥ 32,5 mg/dl), seguido por la presión sistólica disminuida (< 97 mm Hg) y finalmente por los niveles elevados de creatinina (≥ 1,75 mg/dl). Conclusión: el análisis mediante el CART permite clasificar en forma temprana la probabilidad de muerte por un árbol de riesgo que incluye el BUN ≥ 32,5 mg/dl, la presión sistólica 37 mg/dL (OR: 10.8; 95% CI: 4.10-28.8) and a systolic blood pressure (SBP) ≤ 125 mmHg (OR: 3.42; 95% CI: 1.15-10.0). The classification and regression tree (CART) model identified elevated levels of as the best predictor of mortality, followed by a decreased systolic pressure (< 97 mmHg), and finally due to elevated creatinine levels (≥ 1,75 mg/dL). Conclusion: The analysis using the classification and regression tree (CART) model can provide an early classification of the probability of death by a risk tree that includes BUN ≥ 32.5 mg/dL, systolic pressure

El aneurisma del seno de Valsalva es una entidad rara en la población general, con una incidencia de 0,14 al 3,5% en cirugías de corazón abierto; con un espectro clínico amplio y complicaciones cardiacas mecánicas o eléctricas que pueden ser fatales. En mujeres embarazadas también ha sido reportada esta entidad en unos cuantos casos en la literatura médica publicada. Se presenta un caso de una paciente gestante con aneurisma de seno de Valsalva, sus complicaciones y las medidas terapéuticas que se llevaron a cabo, además de una revisión del tema.

Background: Several models have been developed to assess bleeding risk in patients with venous thromboembolism, such as HAS-BLED, but their external validity has not been adequately assessed., Objective: The objective of the study was to evaluate the discriminative ability and calibration of the HAS-BLED scale for predicting 1-month bleeding risk in patient's anticoagulated for venous thromboembolism., Materials and Methods: External validation study of a prediction model based on a retrospective cohort of patients with venous thromboembolism treated between November 2019 and January 2022. Calibration of the HAS-BLED scale was evaluated using the Hosmer-Lemeshow test and the ratio of observed to expect events within each risk category. Discriminatory ability was assessed using the area under the curve (AUC) of a receiver operating characteristic curve., Results: We included 735 patients (median age 64 years, female sex 55.2%), pulmonary embolism was diagnosed in most patients (60.7%), and 4.9% presented bleeding events. Regarding calibration, the HAS-BLED scale systematically underestimates the risk both in the general population (ROE 3.76, p < 0.001) and in cancer patients (ROE 4.16). The Hosmer-Lemeshow test rejected the hypothesis of adequate calibration (p < 0.001). Discriminatory ability was limited both in the general population (AUC = 0.57, 95% confidence interval [CI]: 0.48-0.66) and in the subgroup with active cancer (AUC = 0.53, 95% CI: 0.36-0.69)., Conclusion: The HAS-BLED scale in patients with venous thromboembolism underestimates the risk of bleeding at 1 month and has a low ability to discriminate high-risk patients. Cautious interpretation of the scale is recommended until additional evidence is available.

Background: Helicobacter pylori infection is one of the most common chronic infections in the world, and is acquired mainly during childhood. It is not clear to which extent a primary infection protects the child from reinfection. Our aim was to determine the possible protection conferred by a primary infection against H. pylori reinfection in children., Methods: A follow-up study with 120 children distributed in two cohorts; the first included 80 children without previous H. pylori infection (primo-infection cohort); the second included 40 infected children successfully eradicated (reinfection cohort). Cohorts were monitored during 2 years with urea-breath-test (UBT) at 3, 6, 9, 12, 18 and 24 months for the acquisition of H. pylori infection. We compared the rate of reinfection in eradicated children with the rate of infection in children without previous infection. H. pylori infection during the follow-up was analyzed and compared between cohorts using chi2 and survival curves. A questionnaire was performed for the evaluation of possible risk factors for infection in both cohorts., Results: No significant differences in rates of primo-infection or reinfection were found; 17 (21.2%) primo-infections and 10 (25%) reinfections were documented. Most of the primo-infections (14/17) occurred in the first year of follow-up. In contrast, reinfection episodes occurred more frequently during the second year (6/10). In both cohorts, most infections were transient. Risk factors were similar for both, primo and reinfection cohorts., Conclusion: A primary infection does not protect from reinfection in the population of children studied.

Objective: To evaluate two staining procedures used in the detection of P. carinii., Material and Methods: Bronchoalveolar lavage samples were obtained from 20 immunosupressed rats. The samples were stained by three procedures: o-toluidine blue (OTB), Diff Quik (DQ), and a silver stain as the gold standard. The microscopic search for P. carinii was made independently by two observers., Results: Fifteen of the 20 samples were positive to P. carinii with the silver stain. The sensitivity with DQ was 27% and the specificity 100%. With OTB the sensitivity was 93% and the specificity was 80%. The inter-raters' agreement by kappa was 0.11 for DQ and 0.53 for OTB., Conclusion: Our results suggest that the silver stain should be used for an adequate diagnosis of pneumonia caused by P. carinii.

Hepatitis B (HVB) is a worldwide spread health problem. It has been assessed that there are more than 300 millions of carriers. HVB has a special concern for health care workers (HCW's) due to the high risk among them of getting the infection in clinic-setting areas. According to some estimation, the risk for hepatitis B among HCW's is 2 to 10 times higher than the risk for general population. The risk is related to the degree of direct contact with blood and body fluids, as well as, with the frequency of traumatic exposure in the work place. The control of this infection is based on the observance of universal precautions and the vaccination, since there is not treatment against this disease. The results of an efficacy-evaluation of DNA recombinant vaccine against hepatitis B are reported; 174 HCW's were studied; three dosages of vaccine were administered (0.1st and 6th month) by I.M. via. In addition, three serum samples were collected at 0, 1st and 9th month after vaccine administration. We did not find carriers of surface antigen of hepatitis B. With regards to seroconverted individuals we observed the following results: there were a satisfactory response to the vaccine in 163 individuals (93.7%); however, 8 (4.6%) persons did not reach titles of protective antibodies and 3 (1.7%) did not show seroconversion at all. Therefore, 11 persons (6.3% of the total) did not result immunized. The secondary reactions to the vaccines were low in frequency and mainly of local presentation. Among the study population we did not find chronic carries of hepatitis B.(ABSTRACT TRUNCATED AT 250 WORDS)

With the purpose of evaluating the usefulness of clinical data and a coagglutination test for the diagnosis of streptococcal pharyngeal tonsillitis, a study was carried out comparing both methods with the standard pharynx culture (gold standard). One hundred and forty-one patients clinically diagnosed with pharyngeal tonsillitis were analyzed. 80 other patients diagnosed with rhino-pharyngitis were used as control groups as well as a group of 66 healthy patients. It was found that the presence of pus in the tonsils and the absence of rhinorrhea and/or a productive cough were isolated clinical variables which showed a significant difference when comparing those cases with a positive or a negative culture (P less than 0.01). These clinical data had a sensitivity and adequate negative predictive values (68 to 83% and 90 to 92%, respectively); specificity was 44 to 74% and the positive predictive value from 24 to 36%. The gathering of combined clinical indexes with different symptoms and signs, were not greater than isolated data. The coagglutination test in those cases of pharyngeal tonsillitis showed greater better specificity (98%) and positive predictive value (93%), but saw no improvement in sensitivity (72%) nor in the negative predictive value (91%), which is why when faced with a negative coagglutination test, it is still necessary to perform a throat culture due to the risk which the patient may be exposed to when no treatment is given. The analysis of the advantages and disadvantages in the routine use of coagglutination and cultures in their particular cases, allows us to conclude that in daily clinical practice the use of clinical criteria is of greater usefulness.(ABSTRACT TRUNCATED AT 250 WORDS)

The per centum distribution of T and B lymphocytes was determined in 30 full term newborns showing adequate development for their gestational age and in 42 full term newborns showing in utero malnutrition. A significant decrease (p less than 0.001) of both lymphocytic subpopulations was found in the in utero malnutrition group. The possibility of a decreased efficiency of the immune response in this group of patients is discussed.

During measles infection in human beings, depression of cellular immunity appears. The authors studied several groups of children with measles complaining of various degrees of malnutrition in terms of rosette forming lymphocytes in peripheral blood; marked reduction of T lymphocytes were seen in all of the groups during the acute stage of the disease, that persisted up to two weeks after the exanthematous stage. When comparison was established of eutrophic and 1st degree malnourished children with those affected with 3rd degree malnutrition, differences were found in the recovery of the number of rosett-E forming cells.

The sensitivity to chloramphenicol and ampicillin of 127 strains of H. influenzae was tested. One hundred and one strains were obtained from the pharyngeal exudate of 828 healthy carriers under 5 years of age and 26 from the spinal fluid of children with meningoencephalitis. Sixty per cent of isolations corresponded to type b; 40 per cent were non typical and we only identified one type e. All H. influenzae obtained from spinal fluid corresponded to type b. The frequency of healthy carriers was greater in intrafamily contacts of children with H. influenza meningoencephalitis (p less than 0.01). Percentages of resistance to ampicillin varied between 6 and 23% for the different groups; we found no statistical difference among them (p less than 0.2). The prevalence of H. influenza resistant to ampicillin in the population studied was 1.2% for type b strains and 0.2% for non typical bacteria. Fourteen per cent of penicillin resistant type b strains were identified; all 127 isolations were to chloramphenicol; therefore, we recommend this drug instead of ampicillin for the treatment of H. influenza infections, with the exception of acute otitis media.

The study included 22 patients with meningoencephalitis and hypertensive cranial syndrome from cerebral edema. Mannitol was given to 13 cases and dexamethasone to 9. There were three therapeutic failures in the group given mannitol and none in that of dexamethasone (p greater than 0.05). Both drugs showed similar effect in the duration of the hypertensive cranial syndrome (39-44 hrs). Patients treated with mannitol showed hyponatremia after 48 hours. No untoward effects appeared in patients given dexamethasone.

Two cases are reported of severe type of S. aureus cellulitis which led to the production of mycotic aneurysms of the internal carotid artery. This situation has not been previously described in the literature. Analysis is made of the infectious pathogenesis of mycotic aneurysms.

Samples of otic secretion for culture were taken to 50 children with suppurative chronic otitis media; two techniques were followed: with a cotton swab from the external meatus or with a sterile metal aspirator, through the tympanic perforation under microscopic control. To 20 of them with unilateral chronic otitis media, a swab with product from the external meatus of the healthy ear was also taken; in 65% of the latter, the same germs were found in both ears, but when the sample was taken with the aspirator, only in 15% were the germs the same (p less than 0.01). Two or more germs were isolated in 54% of the ears following the technique of the swab and in 32% with the aspiration. The predominant microorganisms with the swab technique were gram-positive cocci (S. epidermidis 48% S. aureus 16%); while the aspiration technique reported gram-negative germs in 96% of cultures (Proteus sp. 42%, Pseudomonas sp. 30% and S. aureus only in 14%). We believe that the sample obtained with a swab has a high degree of contamination with the normal flora of the external meatus; therefore, it should be relinquished.

No clinical, cytochemical nor electroencephalographic standards of behavior, specific for each etiology were found in a series of 67 cases of viral infection of the nervous system; however, the severeness was greater in cases of infectious mononucleosis with encephalic involvement and in cases caused by Coxsackie B5 possibly because these appeared in younger patients. The group with greater percentage of definitive motor and intellectual sequelae was found in cases with infectious mononucleosis and ECHO. Cases due to herpes simplex were not more severe during the acute stage, but followed a course with an important percentage of definitive sequelae. Meningoencephalitides from parotiditis were milder, and only in one case did they show permanent motor sequelae.

The study included 205 children with measles seen after an epidemic outbreak in Distrito Federal during the first six months of 1976. 65.8% of the cases had not been given specific immunization and out of the 70 vaccinated cases (34.2%), one half of them were under one year old and were not given re-enforcement afterwards. The clinical picture suffered no changes in vaccinated children, 40% of infants showed initial exanthema on chest and abdomen with centrifugal distribution and in 41.5% of them, diarrhea appeared during the prodromal period. The most outstanding elements of this epidemic outbreak were the high number of sensible cases and the high percentage of children vaccinated before the age of one year and who were not later given re-vaccination. Indequate handling of the vaccine or combination of vaccine withe gammaglobulin used in 1969 and 1970, are also mentioned as a possibility to explain failures of the vaccine in ths group of well vaccinated children.

Through Scott's tubes, intraventricular administration of amynoglucoside antibiotics was given to two groups of patients: a) ten children with purulent meningitis and ventricular ependymitis due to gram - negative germs without malformation of the central nervous system (CNS) and b) sixteen children with ventricular ependymitis and malformation of the CNS. The duration of treatment was three weeks and no deaths issued in the first group. In the second group, there were four therapeutic failures related with the existence of encephalodysplasia or intraventricular wailing. The results described are very encouraging and allow to foresee a marked drop in the lethality of ventricular ependymitis.

The various classes of immunoglobulins with antibody function against E. histolytica were studied in 8 children with amebic liver abscess and in 7 with acute intestinal amebiasis. The predominant fraction was IgG in 7 patients from the first group and in 1 from the second; this suggests a secondary type humoral immune response which implies a previous experience with E. histolytica antigens. A definitive predominance of IgM was shown in a patient with amebic liver abscess, the same as in primary humoral immune response. Humoral antibodies did not develop in the remaining 6 patients with acute intestinal amebiasis. The disparateness of the humoral immune response found in these cases make it difficult to speculate on the role of immunoglobulins in the pathogenesis or in immunologic protection in amebiasis. Possibly, the most important is the participation of cellular immunity.