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Introducción. El envejecimiento y las comorbilidades afectan la cognición y el sistema sensoriomotor de las personas. La pérdida de equilibrio es una de las principales causas de caídas en adultos mayores, por lo que monitorear su desempeño funcional es importante. El sistema de evaluación de equilibrio identifica factores de riesgo para caídas. Objetivos. Identificar las propiedades psicométricas de validez y confiabilidad entre evaluadores y estimar el valor de corte óptimo del BESTest para así diferenciar entre adultos que tienen o no riesgo de caídas. Métodos. Estudio observacional de validez y confiabilidad en el que participaron 221 adultos de entre 50 y 80 años capaces de caminar, con o sin dispositivo de asistencia, de forma independiente durante seis metros y de realizar tareas de equilibrio sin fatiga. Se indagaron datos sociodemográficos, clínicos e historial de caídas. Resultados. Se encontró una correlación significativa entre el sistema de equilibrio con la escala de confianza en las actividades cotidianas (r=0,47, p

David Corredor-Orlandelli,1,* Santiago Sambracos-Parrado,1,* Santiago Mantilla-García,1 Josué Tovar-Tirado,1 Valentina Vega-Ramírez,1 Santiago David Mendoza-Ayús,1 Laura Catalina Peña,1 María Fernanda Leal,1 Juliana Rodríguez-Carrillo,1 Juanita León-Torres,1 Juan Mauricio Pardo-Oviedo,2 Katherine Parra Abaunza,3 Nora Contreras Contreras Bravo,1 Oscar Ortega-Recalde,1 Dora Janeth Fonseca Mendoza1 1Center for Research in Genetics and Genomics – CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia; 2School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; 3Hospital Universitario Mayor – Méderi, Universidad del Rosario, Bogotá, Colombia*These authors contributed equally to this workCorrespondence: Dora Janeth Fonseca MendozaCenter for Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Cra 24 # 63C69, Bogotá, 112111, ColombiaTel/Fax +57 12920200Email dora.fonseca@urosario.edu.coBackground: Paraoxonase-1 (PON1), a glycoprotein associated with serum high-density lipoprotein (HDL), has a central role in metabolizing lipid peroxides, exhibiting antiatherogenic properties. The polymorphism p.Q192R has been previously associated with coronary artery disease (CAD) susceptibility and clopidogrel response.Purpose: We aimed at investigating the association of PON1 p.Q192R with CAD and clopidogrel response in Colombian population.Patients and Methods: The study was conducted among 163 patients diagnosed with CAD and treated with clopidogrel. The allele frequencies for the PON1 192Q and 192R alleles were determined in cases and Latin-American controls obtained from the public database gnomAD (n = 17,711). Response to clopidogrel was determined by assessing the platelet function using the INNOVANCE PFA-200 System. We determined the association between PON1 p.Q192R polymorphism, increased susceptibility to CAD and high on-treatment platelet reactivity (HPR) by using odds ratio (OR) and 95% confidence interval (CI) on four genetic models.Results: The allele frequencies for the PON1 192Q and 192R alleles were 0.60 and 0.40, respectively. The allele distribution was found to be statistically different from the control group and other ethnic groups. The allele 192R was positively associated with decreased susceptibility to CAD under a dominant model (OR, 0.58; 95% CI, 0.42– 0.8; P < 0.01). We found no association between the polymorphism and HPR.Conclusion: We propose that PON1 p.Q192R is a potentially useful marker for CAD susceptibility in the Colombian population and lacks association with HPR under clopidogrel treatment.Keywords: PON1, genetic risk, cardiovascular disease susceptibility, platelet reactivity, clopidogrel

This collaborative meta-analysis was supported by the Swiss National Science Foundation and the Laura and John Arnold Foundation (grant supporting the post-doctoral fellowship at the Meta-Research Innovation Center at Stanford (METRICS), Stanford University). The funders had no role in the design of this collaborative meta-analysis; in the collection, analysis, and interpretation of data; or in the report writing., We would like to express our warm gratitude to all participating patients and convalescent plasma donors. We thank Katja Suter and Sina Ullrich, University of Basel, for their administrative assistance. For their helpful contribution to individual trials, we thank Erica Wood, Iain Gosbell, Richard Charlewood, Thomas Hills, Veronica Hoad, Kristina Kairaitis, Aikaj Jindal, John Gerrard, Hong Foo, Adam Stewart, and Nanette Trask (ASCOT trial); Amalia Bravo-Lindoro, Ral Carrillo-Esper, Karla Maldonado-Silva, Catalina Casillas-Suárez, Orlando Carrillo-Torres, Sandra Murrieta, Elizabeth Diaz-Padilla, Eli Omar Zavaleta, Yadira Bejar-Ramirez, and Evelyn Cortina-de la Rosa (CPC-SARS trial); Sheri Renaud, Roel Rolando-Almario, and Jacqueline Day (NCT04385199 trial); Sandra Tingsgrd, MD, Karen Brorup Heje Pedersen, MD, Michaela Tinggaard, MD, Louise Thorlacius-Ussing, MD, Clara Lundetoft Clausen, MD, Nichlas Hovmand, MD, Simone Bastrup Israelsen, MD, Cecilie Leding, MD, Katrine Iversen, MD, Maria Engel Miller, MD, Hkon Sandholdt, MSc biostatistician (CCAP-2 trial). On behalf of the IRCT20200310046736N1 trial, we thank the Khuzestan Blood Transfusion Organization for specialized assistance in the preparation and maintenance of plasma samples. On behalf of the NCT04332835 trial, we thank all the members of the "PC-COVID-19 Group" at the Clinica del Occidente and Hospital Universitario Mayor Mederi in Bogota, and Clinica CES in Medellin. On behalf of the NCT04403477 trial, we thank Miles Carroll for his support regarding the antibody testing in Bangladesh. The Co-CLARITY team would like to extend their gratitude to the Department of Science and Technology Philippine Council for Health Research and Development and the UP-Philippine General Hospital for all their support in the setting up and conduct of the trial. For helpfully communicating details of their trial, we thank members of the PlasmAr trial, NCT04359810 trial (Max O´Donnell), NCT04468009 trial, and CTRI/2020/05/025299 trial. Support for title page creation and format was provided by AuthorArranger, a tool developed at the National Cancer Institute (https://www.cancer.gov/)., During the conduct of the study, the following is reported: Dr. Berry reports being employee with ownership role at Berry Consultants (receives payments for statistical modeling and design of REMAP-CAP). Dr. Castillo reports grants from DOST PCHRD. Dr. Daly reports grants from Medical Research Future Fund (Australian Govt) and RBWH. Dr. Denkinger reports grants from German Ministry for Education and Research. Dr. Dumagay reports grants from Philippine Council for Health Research and Development. Dr. Dunachie reports grants from UK Department of Health and Social Care, grants from UK National Institute of Health Research. Dr. Gauiran reports grants from Department of Science and Technology—Philippine Council for Health Research and Development. Dr. Gordon reports grants from NIHR, grants from NIHR Research Professorship (RP-2015-06-18), and non-financial support from NIHR Clinical Research Network. Dr. Higgins reports grants from NHMRC and from the Minderoo Foundation. Dr. Hills reports grants from Health Research Council of New Zealand. Dr. Holm reports grants from Swedish Government Funds for Clinical Research (ALF). Dr. Janssen and Dr. Müller-Tidow report grants from the Federal Ministry of Education and Research in Germany (BMBF) to the RECOVER clinical trial. Dr. Krapp reports grants from Department of Foreign Affairs, Trade, and Development of Canada, grants from Fundación Telefónica del Perú. Dr. J. Lim reports grants from the Department of Science and Technology, Philippine Council for Health Research and Development. Dr. Lucero reports grants from Philippine Council for Health Research and Development. Dr Manrique reports economic support from Grupo ISA Intercolombia for the project development of trial NCT04332835. Drs. McQuilten and Wood report grants from Medical Research Future Fund. Dr. McVerry reports grants from The Pittsburgh Foundation, Translational Breast Cancer Research Consortium, and from UPMC Learning While Doing Program. Mr. Mouncey reports grants from National Institute for Health Research and from the European Union FP7: PREPARE. Dr. Najdovski reports payment from KUL Leuven to Belgian Red Cross for supply of convalescent plasma. Dr. Nichol reports grants from Health Research Board of Ireland. Dr. D. Roberts reports grants from the National Institute for Health (UKRIDHSC COVID-19 Rapid Response Rolling Call—Grant Reference Number COV19-RECPLAS) and the European Commission (SUPPORT-E #101015756). Dr. Rowan reports grants from the European Commission and from the UK National Institute for Health Research. Dr. Shankar-Hari reports grants from National Institute for Health Research UK, grants from UKRI-National Institute for Health Research UK. Dr. Turgeon reports grants from Canadian Institutes of Health Research. Dr. Venkatesh reports grants from Baxter. Dr. Webb reports grants from National Health and Medical Research Council, grants from Minderoo Foundation. Dr. Zacharowski reports grants from EU Horizon 2020. The ASCOT trial team (Drs Bowen, Daly, Davis, Denholm, Hammond, Jha, L. Lim, McQuilten, Molton, Morpeth, O’Sullivan, Paterson, Perry, Price, Rees, Roberts, Rogers, Sasadeusz, Snelling, Tong, Venkatesh, Wood) is funded by grants from from Royal Brisbane and Women’s Hospital Foundation, Pratt Foundation, Minderoo Foundation, BHP Foundation, Hospital Research Foundation, Macquarie Group Foundation, Health Research Council of New Zealand, Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE), and the collection and supply of convalescent plasma was conducted within Lifeblood’s funding arrangements. The CONFIDENT trial is funded by the Belgian KCE (blood establishments received payment for the convalescent plasma supplied in the clinical trial). REMAP-CAP was supported in part by funding from UKRIDHSC COVID-19 Rapid Response Rolling Call (Grant Reference Number COV19-RECPLAS). Collection of convalescent plasma for REMAP-CAP was funded by the Department of Health and Social Care, UK. The IRCT20200310046736N1 trial was supported by the Ahvaz Jundishapur University of Medical Sciences (Grant No. R.AJUMS.REC.1399.003, Dr. Pouladzadeh). The PC-COVID-19 Group is supported by the Universidad del Rosario, IDCBIS, ISA Group and Suramericana (Colombia). Outside the submitted work, the following is reported: Dr. Axfors reports postdoctoral grants from the Knut and Alice Wallenberg Foundation, Uppsala University, the Swedish Society of Medicine, the Blanceflor Foundation, and the Sweden-America Foundation. Dr. Aomar reports personal fees from SOBI, GEDEON RICHTER, and GSK. Dr. Benfield reports grants from Novo Nordisk Foundation, Simonsen Foundation, Lundbeck Foundation, Kai Hansen Foundation, Erik and Susanna Olesen’s Charitable Fund; grants and personal fees from GSK, Pfizer, Gilead; and personal fees from Boehringer Ingelheim, MSD, and Pentabase ApS. Dr. Estcourt reports being an investigator on the RECOVERY trial. Dr. Gordon reports personal fees from GlaxoSmithKline, Bristol Myers Squibb, and 30 Respiratory. Dr. Jha reports grants and personal fees from Baxter Healthcare, personal fees from Astra Zeneca, grants from NephroPlus. Dr. Laterre reports personal fees from Adrenomed. Dr. McVerry reports grants from NIH/NHLBI and Bayer Pharmaceuticals, Inc. Dr. Mondragon reports financial activities outside the submitted work (employment at Johnson & Johnson). Dr. Perry reports partner being employed at CSL and owning shares in CSL. Dr. Paterson reports involvement with ALLIANCE trial of COVID-19 treatments. Dr. J. Roberts reports other COVID-19 related trials (in different patient groups): tocilizumab in ICU patients; hydroxychloroquine dosing in ICU patients; planned study of remdesivir pharmacokinetics in patients during expanded access program; and in silico evaluation of ivermectin dosing. Dr Sasadeusz reports grants from various Pharma companies including Gilead Sciences, Abvvie, Merck, and Takeda. Dr. Zacharowski reports personal fees from Biotest AG, CSL Behring, GE Heathcare, and is President of the ESAIC., Background: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX). Methods: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care., Amalia Bravo-Lindoro, BHP Foundation, Blanceflor Foundation, Department of Foreign Affairs, Trade, and Development of Canada, Eli Omar Zavaleta, Erik and Susanna Olesen’s Charitable Fund, Federal Ministry of Education and Research in Germany, Fundación Telefónica del Perú, IDCBIS, ISA Group and Suramericana, Kai Hansen Foundation, Katja Suter and Sina Ullrich, Khuzestan Blood Transfusion Organization, Macquarie Group Foundation, Medical Research Future Fund, NephroPlus, RBWH, Roel Rolando-Almario NCT04385199, Royal Brisbane, Sheri Renaud, Simonsen Foundation, UKRI-National Institute for Health Research UK, UKRIDHSC COV19-RECPLAS, UP-Philippine General Hospital CTRI/2020/05/025299, NCT04359810, NCT04468009, Women’s Hospital Foundation, National Institutes of Health, National Heart, Lung, and Blood Institute, Pittsburgh Foundation, Pfizer, Baxter International, Stanford University, Gilead Sciences, National Institute on Handicapped Research RP-2015-06-18, Meso Scale Diagnostics, Universität Basel, Laura and John Arnold Foundation, Health Research Board, Pratt Foundation, Canadian Institutes of Health Research, National Institute for Health Research, Department of Health and Social Care, European Commission 101015756, National Health and Medical Research Council, Department of Science and Technology, Ministry of Science and Technology, India, Health Research Council of New Zealand, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Sweden-America Foundation, Bundesministerium für Bildung und Forschung, Lundbeckfonden, Knut och Alice Wallenbergs Stiftelse, Seventh Framework Programme, Ahvaz Jundishapur University of Medical Sciences, Université Pierre et Marie Curie, Uppsala Universitet, Horizon 2020, Svenska Läkaresällskapet, Universidad del Rosario, Pharmaceuticals Bayer, Novo Nordisk Fonden, Department of Science and Technology, Philippines, Philippine Council for Health Research and Development, Minderoo Foundation

Background and aims: a high nutritional risk can independently be associated with a longer hospital stay in elderly patients. This study aims to establish the prevalence of the risk of malnutrition and its associated factors in a high-complexity level hospital in Bogotá, Colombia, during 2018. Methods: a cross-sectional study. The prevalence of the risk of malnutrition was measured using a malnutrition-screening tool (MST), and the association with hospital stage, age, and patient diagnoses was assessed. Results: a total of 7,192 patients comprised the cohort. Age range was 61 to 108 years, with an average of 77.1 ± 9.2 years, and subjects were mostly female (55.5 %). We identified as main conditions urinary tract infections (8.4 %), congestive heart failure (5.4 %), and chronic obstructive pulmonary disease with an acute exacerbation (4.6 %). The prevalence of the risk of malnutrition was 41.4 %, significantly associated with longer hospital stays (p0.001), older age (p0.001), and a diagnosis of delirium (OR = 5.98, 95 % CI: 2.78 to 12.86), diarrhea and gastroenteritis (OR = 5.01, 95 % CI: 2.44 to 10.32), gastrointestinal hemorrhage (OR = 4.44, 95 % CI: 2.38 to 8.28), specified pneumonia (OR = 4.43, 95% CI: 2.11 to 9.30), and high blood pressure (3.94, 95 % CI: 2.07 to 7.50). Other diagnoses included abdominal pain (other) (OR = 3.80, 95 % CI: 1.81 to 7.99), urinary tract infections (OR = 3.64, 95 % CI: 2.07 to 6.24), acute bronchitis (OR = 3.22, 95 % CI: 1.56 to 6.65), and bacterial pneumonia (OR = 3.02, 95 % CI: 1.65 to 5.55). Conclusion: the prevalence of the risk of malnutrition in our institution is approximately one in two patients, with a significant association to increased hospital stay ≥ 8 days, patient age ≥ 80 years, and mainly diagnoses of delirium, diarrhea, and gastroenteritis of suspected infectious etiology.Antecedentes y objetivos: el alto riesgo nutricional puede asociarse independientemente a una estancia hospitalaria más prolongada en los pacientes ancianos. Este estudio tiene por objetivo establecer la prevalencia del riesgo de malnutrición y sus factores asociados en un hospital de alta complejidad de Bogotá (Colombia) durante 2018. Métodos: este fue un estudio transversal. Se determinó la prevalencia del riesgo de malnutrición mediante la herramienta de detección MST y se evaluó la asociación con la estancia hospitalaria, la edad y el diagnóstico del paciente. Resultados: en total, 7192 pacientes conformaron la cohorte. El rango de edad era de 61 a 108 años, con un promedio de 77,1 ± 9,2 años, siendo los sujetos en su mayoría de sexo femenino (55,5 %). Se identificaron como condiciones principales las infecciones del tracto urinario (8,4 %), la insuficiencia cardiaca congestiva (5,4 %) y la enfermedad pulmonar obstructiva crónica (4,6 %). La prevalencia del riesgo de desnutrición fue del 41,4 %, asociada a las estancias hospitalarias prolongadas (p0,001), la edad avanzada (p0,001) y los diagnósticos de delirium (OR = 5,98, IC 95 %: 2,78 a 12,86), diarrea y gastroenteritis (OR = 5.01, IC 95 %: 2.44 a 10.32), hemorragia gastrointestinal (OR = 4.44, IC 95 %: 2.38 a 8.28), neumonía específica (OR = 4.43, IC 95 %: 2.11 a 9.30) e hipertensión arterial (3.94, IC 95 %: 2.07 a 7.50). Otros diagnósticos asociados fueron: dolor abdominal (otros) (OR = 3.80, IC 95 %: 1.81 a 7.99), infecciones del tracto urinario (OR = 3.64, IC 95 %: 2.07 a 6.24), bronquitis aguda (OR = 3.22, IC 95 %: 1.56 a 6.65) y neumonía bacteriana (OR = 3.02, IC 95 %: 1.65 a 5.55). Conclusión: la prevalencia del riesgo de desnutrición en la institución es aproximadamente de uno de cada dos pacientes, con una asociación significativa al aumento de la estancia hospitalaria superior a 8 días, a la edad del paciente mayor de 80 años y, principalmente, a los diagnósticos de delirium, diarrea y gastroenteritis.

Clopidogrel, an oral platelet P2Y12 receptor blocker, is used in the treatment of acute coronary syndrome. Interindividual variability in treatment response and the occurrence of adverse effects has been attributed to genetic variants in CYP2C19. The analysis of relevant pharmacogenes in ethnically heterogeneous and poorly studied populations contributes to the implementation of personalized medicine. We analyzed the coding and regulatory regions of CYP2C19 in 166 patients with acute coronary syndrome (ACS) treated with clopidogrel. The allele frequencies of CYP2C19 alleles *1, *2, *4, *17, *27 and *33 alleles were 86.1%, 7.2%, 0.3%, 10.2%, 0.3% and 0.3%, respectively. A new potentially pathogenic mutation (p.L15H) and five intronic variants with potential splicing effects were detected. In 14.4% of the patients, a new haplotype in strong linkage disequilibrium was identified. The clinical outcome indicated that 13.5% of the patients presented adverse drugs reactions with a predominance of bleeding while 25% of these patients were carriers of at least one polymorphic allele. We propose that new regulatory single-nucleotide variants (SNVs) might potentially influence the response to clopidogrel in Colombian individuals.

Introduction: the identification of nutritional risk at hospital admission is important to establish timely interventions in the COVID-19 patient care cycle, due to a high risk of it being associated with complications. Objective: to determine the association between the level of nutritional risk upon admission and in-hospital mortality at 28 days in patients diagnosed with COVID-19 treated between March and October 2020 in two hospital institutions in Colombia. Methods: a retrospective, observational study. Hospitalized patients with a diagnosis of COVID-19 were included and assessed by the Nutrition Service using the nutritional risk identification in emergencies scale, adapted from the NRS 2002 scale. In-hospital mortality at 28 days was analyzed as the primary endpoint, and hospital stay, admission to Intensive Care Unit (ICU), and requirement for mechanical ventilation as secondary endpoints. Results: a total of 1230 patients were included, with a mean age of 65.43 ± 15.90 years, mainly men (57.1 %, n = 702). A high nutritional risk (≥ 2 points) was identified in 74.3 % (n = 914). Patients with a high nutritional risk had a greater probability of in-hospital death at 28 days (HRadj: 1.64; 95 % CI: 1.11-2.44), and a greater risk of requiring mechanical ventilation (OR = 1.78; 95 % CI: 1.11-2.86) or ICU admission (OR = 1.478; 95 % CI: 1.05-2.09), as well as hospital stay longer than 7 days (OR = 1.91; 95 % CI: 1.47-2.48). Conclusions: patients with a diagnosis of COVID-19 at high nutritional risk had a significantly higher in-hospital mortality at 28 days and a higher probability of requiring mechanical ventilation, ICU admission, and prolonged hospital stay.Introducción: la identificación del riesgo nutricional al ingreso hospitalario es importante para establecer intervenciones oportunas en el ciclo de atención del paciente con COVID-19, debido al alto riesgo de asociarse a complicaciones. Objetivo: determinar la asociación entre el nivel de riesgo nutricional al ingreso y la mortalidad intrahospitalaria a 28 días en pacientes con diagnóstico de COVID-19 atendidos entre marzo y octubre de 2020 en una red de dos instituciones hospitalarias de Colombia. Metodología: estudio observacional retrospectivo. Se incluyeron pacientes hospitalizados con diagnóstico de COVID-19 y valorados por el Servicio de Nutrición con la escala de identificación de riesgo nutricional en emergencias, adaptada de la escala NRS 2002. Se analizó como resultado principal la mortalidad intrahospitalaria a 28 días y como secundarios, la estancia hospitalaria, el ingreso a la Unidad de Cuidados Intensivos (UCI) y el requerimiento de ventilación mecánica. Resultados: se incluyeron 1230 pacientes, con edad promedio de 65,43 ± 15,90 años, principalmente hombres (57,1 %, n = 702). Se identificó un alto riesgo nutricional (≥ 2 puntos) en el 74,3 % (n = 914). Se evidenció que los pacientes con alto riesgo nutricional tenían una mayor probabilidad de muerte intrahospitalaria a 28 días (HR: 1,64; IC 95 %: 1,11-2,44) y un mayor riesgo de requerir ventilación mecánica (OR = 1,78; IC 95 %: 1,11-2,86), de ingreso en la UCI (OR = 1,478; IC 95 %: 1,05-2,09) y de estancia hospitalaria superior a 7 días (OR = 1,91; IC 95 %: 1,47-2,48). Conclusiones: los pacientes con diagnóstico de COVID-19 y riesgo nutricional alto presentaron una mortalidad intrahospitalaria a 28 días significativamente mayor y una mayor probabilidad de requerir ventilación mecánica y atención en la UCI, así como estancias hospitalarias prolongadas.

espanolAntecedentes y objetivos: el alto riesgo nutricional puede asociarse independientemente a una estancia hospitalaria mas prolongada en los pacientes ancianos. Este estudio tiene por objetivo establecer la prevalencia del riesgo de malnutricion y sus factores asociados en un hospital de alta complejidad de Bogota (Colombia) durante 2018. Metodos: este fue un estudio transversal. Se determino la prevalencia del riesgo de malnutricion mediante la herramienta de deteccion MST y se evaluo la asociacion con la estancia hospitalaria, la edad y el diagnostico del paciente. Resultados: en total, 7192 pacientes conformaron la cohorte. El rango de edad era de 61 a 108 anos, con un promedio de 77,1 ± 9,2 anos, siendo los sujetos en su mayoria de sexo femenino (55,5 %). Se identificaron como condiciones principales las infecciones del tracto urinario (8,4 %), la insuficiencia cardiaca congestiva (5,4 %) y la enfermedad pulmonar obstructiva cronica (4,6 %). La prevalencia del riesgo de desnutricion fue del 41,4 %, asociada a las estancias hospitalarias prolongadas (p Conclusion: la prevalencia del riesgo de desnutricion en la institucion es aproximadamente de uno de cada dos pacientes, con una asociacion significativa al aumento de la estancia hospitalaria superior a 8 dias, a la edad del paciente mayor de 80 anos y, principalmente, a los diagnosticos de delirium, diarrea y gastroenteritis. EnglishBackground and aims: a high nutritional risk can independently be associated with a longer hospital stay in elderly patients. This study aims to establish the prevalence of the risk of malnutrition and its associated factors in a high-complexity level hospital in Bogota, Colombia, during 2018. Methods: a cross-sectional study. The prevalence of the risk of malnutrition was measured using a malnutrition-screening tool (MST), and the association with hospital stage, age, and patient diagnoses was assessed. Results: a total of 7,192 patients comprised the cohort. Age range was 61 to 108 years, with an average of 77.1 ± 9.2 years, and subjects were mostly female (55.5 %). We identified as main conditions urinary tract infections (8.4 %), congestive heart failure (5.4 %), and chronic obstructive pulmonary disease with an acute exacerbation (4.6 %). The prevalence of the risk of malnutrition was 41.4 %, significantly associated with longer hospital stays (p Conclusion: the prevalence of the risk of malnutrition in our institution is approximately one in two patients, with a significant association to increased hospital stay ≥ 8 days, patient age ≥ 80 years, and mainly diagnoses of delirium, diarrhea, and gastroenteritis of suspected infectious etiology.

Convalescent plasma (CP) has emerged as a treatment for COVID-19. However, the composition and mechanism of action are not fully known. Therefore, we undertook a two-phase controlled study in which, first the immunological and metabolomic status of recovered and severe patients were evaluated. Secondly, the 28-day effect of CP on the immune response in severe patients was assessed. Nineteen recovered COVID-19 patients, 18 hospitalized patients with severe disease, and 16 pre-pandemic controls were included. Patients with severe disease were treated with CP transfusion and standard therapy (i.e., plasma recipients, n = 9) or standard therapy alone (n = 9). Clinical and biological assessments were done on day 0 and during follow-up on days 4, 7, 14, and 28. Clinical parameters, viral load, total immunoglobulin (Ig) G and IgA anti-S1-SARS-CoV-2 antibodies, neutralizing antibodies (NAbs), autoantibodies, cytokines, T and B cells, and metabolomic and lipidomic profiles were examined. Total IgG and IgA anti-S1-SARS-CoV-2 antibodies were key factors for CP selection and correlated with NAbs. In severe COVID-19 patients, mostly interleukin (IL)-6 (P =, Highlights • Serum from recovered patients discloses a different composition than that from patients with severe disease. • Latent autoimmunity and anti–IFN–α antibodies are observed in COVID-19. • COVID-19 CP induces an early but transient effect on antibody and cytokine profile of patients with severe disease . • CP decreases activated and effector T cells, and increases memory immune cells. • CP reduces the IL-6/IFN-γ and IL-6/IL-10 ratios.

Resumen Introducción. La enfermedad por coronavirus 2019 (COVID-19) puede llevar a la hospitalización de los pacientes en los casos más graves; por tanto, es necesario establecer recomendaciones teórico-prácticas de intervención nutricional hospitalaria. Objetivo. Identificar las recomendaciones dirigidas a los equipos de salud hospitalarios para brindar atención nutricional a pacientes hospitalizados mayores de 18 años e infectados con COVID-19. Materiales y métodos. Se realizó una revisión de la literatura en PubMed mediante la siguiente estrategia de búsqueda: periodo de publicación: diciembre 1 de 2019 a marzo 21 de 2020; idiomas de publicación: inglés y chino; términos de búsqueda: "Coronavirus Infection", "Severe Acute Respiratory Syndrome" y "Nutrition for Vulnerable Groups". Resultados. Se identificaron 283 artículos en la búsqueda inicial, de los cuales se seleccionaron 6 para analizar las prácticas de atención nutricional hospitalaria. Las áreas de investigación de estas publicaciones fueron soporte nutricional; evaluación de intervenciones para abordar y disminuir la severidad de las complicaciones pulmonares y hepáticas, y efectos de antioxidantes y ácidos grasos omega-3 en adultos con síndrome de dificultad respiratoria aguda. Conclusión. Las recomendaciones para la atención nutricional hospitalaria en pacientes con COVID-19 se basan en procesos de cuidado nutricional y en la gestión de los servicios de alimentación; según estas recomendaciones, se deben establecer estrategias de evaluación de riesgo nutricional, realizar intervenciones de soporte nutricional que reduzcan el riesgo de desnutrición y vigilar los riesgos asociados a la administración del soporte nutricional y las alteraciones metabólicas asociadas a esta enfermedad. Abstract Introduction: Coronavirus disease (COVID-19) may require the hospitalization of patients in the most severe cases. Therefore, it is necessary to establish theoretical and practical recommendations for nutritional interventions at hospitals. Objective: To identify recommendations given to hospital health care teams for providing nutritional care to inpatients over 18 years of age infected with COVID-19. Materials and methods: A literature review was conducted in PubMed using the following search strategy: publication period: December 2019 to March 2020; publication language: English and Chinese; search terms: "Coronavirus Infection", "Severe Acute Respiratory Syndrome" and "Nutrition for Vulnerable Groups". Results: A total of 283 articles were retrieved after completing the initial search, of which 6 were selected to analyze nutrition care practices in the hospital setting. The areas of research of these publications were nutritional support, the evaluation of interventions aimed to manage and reduce the severity of pulmonary and hepatic complications, and the effects of antioxidants and omega-3 fatty acids in adults with acute respiratory distress syndrome. Conclusion: Recommendations for providing nutritional care to COVID-19 inpatients are based on nutritional care processes and food service management. According to these recommendations, nutritional risk assessment strategies should be established, nutritional support interventions aimed at reducing the risk of malnutrition should be carried out, and the risks associated with the administration of nutritional support, as well as COVID-19-re-lated metabolic disorders, should be monitored.

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the etiopathogenic agent of COVID-19, a condition that has led to a formally recognized pandemic by March 2020 (World Health Organization -WHO). The SARS-CoV-2 genome is constituted of 29,903 base pairs, that code for four structural proteins (N, M, S, and E) and more than 20 non-structural proteins. Mutations in any of these regions, especially in those that encode for the structural proteins, have allowed the identification of diverse lineages around the world, some of them named as Variants of Concern (VOC) and Variants of Interest (VOI), according to the WHO and CDC. In this study, by using Next Generation Sequencing (NGS) technology, we sequenced the SARS-CoV-2 genome of 422 samples from Colombian residents, all of them collected between April 2020 and January 2021. We obtained genetic information from 386 samples, leading us to the identification of 14 new lineages circulating in Colombia, 13 of which were identified for the first time in South America. GH was the predominant GISAID clade in our sample. Most mutations were either missense (53.6%) or synonymous mutations (37.4%), and most genetic changes were located in the ORF1ab gene (63.9%), followed by the S gene (12.9%). In the latter, we identified mutations E484K, L18F, and D614G. Recent evidence suggests that these mutations concede important particularities to the virus, compromising host immunity, the diagnostic test performance, and the effectiveness of some vaccines. Some important lineages containing these mutations are the Alpha, Beta, and Gamma (WHO Label). Further genomic surveillance is important for the understanding of emerging genomic variants and their correlation with disease severity.

Introducción: La evolución de un sistema dinámico se puede caracterizar a partir de la construcción de atractores caóticos.Objetivo: Desarrollar una metodología de evaluación de la saturación venosa de oxígeno, fundamentada en los sistemas dinámicos, para pacientes en Unidad de Cuidados Intensivos. Metodología: Se seleccionaron 10 pacientes con diferentes patologías de la Unidad de Cuidados Intensivos Postquirúrgicos, y registró la saturación venosa de oxígeno durante su tiempo de estancia. Con base en estos valores se construyeron atractores caóticos en el mapa de retardo y se evaluaron los valores mínimos y máximos ocupados por el atractor. Resultados: Se halló que la saturación venosa de oxígeno tiene un comportamiento caótico; los valores máximos y mínimos de los atractores en el mapa de retardo variaron entre 22,10 mmHg y 93,70 mmHg.Conclusiones: Se plantea una nueva metodología capaz de caracterizar el comportamiento de la variable monitorizada para la evaluación del paciente crítico.Palabras clave: fractales; dinámica no lineal; modelos teóricos.

A new methodology based on dynamical systems theory has been developed to differentiate normal cardiac dynamic from acute illness by calculating the space occupation of chaotic geometric attractors in the phase space. Objective: The purpose of this study was to apply this methodology to confirm its clinical applicability and the relation between the measures and the appearance of arrhythmic electrical storms.

Clostridium difficile, the causal agent of antibiotic-associated diarrhea, has a complex epidemiology poorly studied in Latin America. We performed a robust genomic and phenotypic profiling of 53 C. difficile clinical isolates established from diarrheal samples from either intrahospital (IH) or community (CO) populations in central Colombia. In vitro tests were conducted to evaluate the cytopathic effect, the minimum inhibitory concentration of ten antimicrobial agents, the sporulation efficiency and the colony forming ability. Eleven different sequence types (STs) were found, the majority present individually in each sample, however in three samples two different STs were isolated. Interestingly, CO patients were infected with STs associated with hypervirulent strains (ST-1 in Clade-2). Three coexistence events (two STs simultaneously detected in the same sample) were observed always involving ST-8 from Clade-1. A total of 2,502 genes were present in 99% of the isolates with 95% of identity or more, it represents a core genome of 28.6% of the 8,735 total genes identified in the set of genomes. A high cytopathic effect was observed for the isolates positive for the two main toxins but negative for binary toxin (TcdA+/TcdB+/CDT− toxin production type), found only in Clade-1. Molecular markers conferring resistance to fluoroquinolones (cdeA and gyrA) and to sulfonamides (folP) were the most frequent in the analyzed genomes. In addition, 15 other markers were found mostly in Clade-2 isolates. These results highlight the regional differences that C. difficile isolates display, being in this case the CO isolates the ones having a greater number of accessory genes and virulence-associated factors.

Clopidogrel, an oral platelet P2Y12 receptor blocker, is used in the treatment of acute coronary syndrome. Interindividual variability in treatment response and the occurrence of adverse effects has been attributed to genetic variants in CYP2C19. The analysis of relevant pharmacogenes in ethnically heterogeneous and poorly studied populations contributes to the implementation of personalized medicine. We analyzed the coding and regulatory regions of CYP2C19 in 166 patients with acute coronary syndrome (ACS) treated with clopidogrel. The allele frequencies of CYP2C19 alleles *1, *2, *4, *17, *27 and *33 alleles were 86.1%, 7.2%, 0.3%, 10.2%, 0.3% and 0.3%, respectively. A new potentially pathogenic mutation (p.L15H) and five intronic variants with potential splicing effects were detected. In 14.4% of the patients, a new haplotype in strong linkage disequilibrium was identified. The clinical outcome indicated that 13.5% of the patients presented adverse drugs reactions with a predominance of bleeding while 25% of these patients were carriers of at least one polymorphic allele. We propose that new regulatory single-nucleotide variants (SNVs) might potentially influence the response to clopidogrel in Colombian individuals.

Background Enterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcare-associated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Due to molecular biology techniques’ higher costs, the approach for identifying and controlling infectious diseases in developing countries has been based on clinical and epidemiological perspectives. Nevertheless, after an abrupt vancomycin-resistant Enterococcus faecium dissemination in the Méderi teaching hospital, ending up in an outbreak, further measures needed to be taken into consideration. The present study describes the vancomycin-resistant Enterococcus faecium pattern within Colombian’s largest installed-bed capacity hospital in 2016. Methods Thirty-three vancomycin-resistant Enterococcus faecium isolates were recovered during a 5-month period in 2016. Multilocus variable-number tandem-repeat analysis was used for molecular typing to determine clonality amongst strains. A modified time-place-sequence algorithm was used to trace VREfm spread patterns during the outbreak period and estimate transmission routes. Results Four clonal profiles were identified. Chronological clonal profile follow-up suggested a transitional spread from profile “A” to profile “B”, returning to a higher prevalence of “A” by the end of the study. Antibiotic susceptibility indicated high-level vancomycin-resistance in most isolates frequently matching vanA gene identification. Discussion Transmission analysis suggested cross-contamination via healthcare workers. Despite epidemiological control of the outbreak, post-outbreak isolates were still being identified as having outbreak-related clonal profile (A), indicating reduction but not eradication of this clonality. This study supports the use of combined molecular and epidemiological strategies in an approach to controlling infectious diseases. It contributes towards a more accurate evaluation of the effectiveness of the epidemiological measures taken regarding outbreak control and estimates the main cause related to the spread of this microorganism. Electronic supplementary material The online version of this article (10.1186/s12879-019-3877-7) contains supplementary material, which is available to authorized users.

Objetivo Establecer una nueva metodología predictiva de la proporción de dengue grave respecto al total anual de infectados de dengue por departamento con base en la teoría de la probabilidad. Métodos Con base en los datos anuales de número de infectados por departamentos en el periodo 2005 -2010, se calculó la proporción entre casos de dengue grave respecto al total para cada año, y se construyeron espacios de probabilidad que evalúan estos eventos en rangos de 0,5 y 0,3. Se determinaron conjuntos de rangos y se calculó probabilidad, desviación media cuadrática y la diferencia entre ellas. Se realizó una predicción del rango de infectados para el 2011 con el promedio aritmético de los valores de los últimos dos años. Resultados Se predijo correctamente el rango en el que se encuentra incluida la proporción de número de infectados de dengue grave sobre el total en cada departamento con una efectividad del 93,3% para el rango de 0,5 y de 86,7% para el de 0,3. Conclusión Se evidenció una autoorganización matemática espacio temporal en la proporción de dengue grave respecto al total que permite establecer predicciones de utilidad para la toma de decisiones de salud pública. Objective To establish a new predictive methodology to determine the proportion of severe dengue with respect to the annual total of dengue infections per department based on the probability theory. Materials and Methods Based on annual data on the number of infected persons by department in the period 2005-2010, the proportion of cases of severe dengue was calculated with respect to the total for each year. Probability spaces were constructed to evaluate these events in the ranges 0.5 and 0.3. Sets of ranges were determined and probability, mean square deviation and the difference between them were estimated. A prediction of the range of infected people for 2011 was made using the arithmetic average of the values of the last two years. Results The range in which the proportion of the number of people infected with severe dengue is included with respect to the total amount in each department was correctly predicted, with an effectiveness of 93.3% for the 0.5 range and 86.7% for the 0.3 range. Conclusion A mathematical spatial-temporal self-organization was found in the proportion of severe dengue with respect to the total, which allows establishing useful predictions for decision-making in public health.

Introducción: se ha encontrado una ley exponencial para sistemas cardíacos dinámicos caóticos, que permite cuantificar las diferencias entre dinámicas cardíacas normales y patológicas Metodología: Se analizaron 120 registros electrocardiográficos, 40 correspondían a sujetos dentro de los límites de la normalidad y 80 con diferentes patologías. . Para cada holter se analizaron los atractores generados con los datos durante 18 horas y a lo largo de la dinámica. Se calculó la dimensión fractal del atractor y su ocupación espacial. A estas medidas se aplicó la evaluación matemática de diagnóstico previamente desarrollada, comparando la evaluación por 18 horas y para todo el registro; finalmente se calculó la sensibilidad, especificidad y coeficiente Kappa. Resultados: Para la dinámica normal, los espacios de ocupación en la cuadrícula Kp estuvieron entre 200 y 381 para la evaluación del holter completo, y entre 201 y 384 en la evaluación durante 18 horas, mostrando la cercanía en las mediciones, lo que permite que la disminución en el tiempo de la evaluación sea consistente, esta misma proximidad se observó para la dinámica enferma y aguda.Conclusión: Se evidenció la aplicabilidad clínica en 18 horas de la ley exponencial en el caótico dinámica cardíaca asociada a arritmias demostrando ser útil para la predicción de la evolución hacia estados agudos de la dinámica. Introduction: an exponential law has been found for chaotic dynamic cardiac systems, making it possible to quantify the differences between normal and pathological cardiac dynamics.Methodology: 120 electrocardiographic records were analyzed, 40 corresponded to subjects within the limits of normality and 80 with different pathologies. For each holter the attractors generated with the data during 18 hours and throughout the dynamics were analyzed. The fractal dimension of the attractor and its spatial occupation were calculated. To these measures was applied the diagnosis mathematical evaluation previously developed, comparing the evaluation for 18 hours and for the whole registry; sensitivity, specificity and Kappa coefficient were finally calculated.Results: For the normal dynamics, the occupancy spaces in the Kp grid were between 200 and 381 for the evaluation of the whole holter, and between 201 and 384 in the evaluation during 18 hours, showing the closeness in the measurements, which allows that the decrease in the time of the evaluation is consistent, this same proximity was observed for the diseased and acute dynamics.Conclusion: It was evidenced the clinical applicability in 18 hours of the exponential law in the chaotic cardiac dynamics associated with arrhythmias showing to be useful for the prediction of the evolution towards acute states of the dynamics.

Introduccion. El riesgo de caidas en adultos mayores se incrementa a consecuencia de la disminucion de la fuerza, la flexibilidad, el equilibrio y los cambios sensoriales, que afectan a la funcionalidad y la calidad de vida. Por tal razon se hace necesario un sistema integral de evaluacion del equilibrio con fines preventivos o para intervenciones terapeuticas tempranas. Objetivo. Presentar los resultados del proceso de traduccion y adaptacion transcultural del sistema de evaluacion del equilibrio (BESTest) al castellano. Sujetos y metodos. Se tradujo al castellano la version original del BESTest, siguiendo el proceso de retrotraduccion y adaptacion cultural y teniendo en cuenta las equivalencias semanticas, idiomaticas, conceptual y experiencial. Posteriormente, la version fue revisada por un panel de expertos que califico la claridad, la coherencia, la pertinencia y la suficiencia. En la prueba piloto participaron 32 adultos de 50-80 anos. Resultados. Se realizo la traduccion completa del instrumento y de las instrucciones para el sujeto y para el evaluador. La mayoria de items de la prueba alcanzaron la puntuacion maxima de 4 (100%), nueve items lograron una calificacion media de 3,9 (99%); un item, una calificacion media de 3,8 (95%), y dos items, una calificacion media de 3,7 (92,5%). Conclusiones. Con este estudio, la comunidad de habla hispana cuenta con un instrumento pertinente, suficiente, coherente y claro para identificar el sistema del equilibrio afectado, enfocar el tratamiento y obtener mejores resultados funcionales a partir de la evaluacion del equilibrio en adultos mayores.

Introducción: una ley exponencial se ha hallado para los sistemas dinámicos caóticos cardiacos, logrando cuantificar las diferencias entre dinámicas cardiacas normales y patológicas.Metodología: Se analizaron 120 registros electrocardiográficos, 40 correspondían a sujetos dentro de los límites de normalidad y 80 con diferentes patologías. Para cada holter se analizaron los atractores generados con los datos durante 18 horas y durante toda la dinámica. Se calculó la dimensión fractal del atractor y su ocupación espacial. A estas medidas se aplicó la evaluación matemática diagnostica desarrollada previamente, comparando la evaluación para 18 horas y para todo el registro; finalmente se calculó la sensibilidad, especificidad y coeficiente Kappa.Resultados: Para las dinámicas normales los espacios de ocupación en la rejilla Kp estuvieron entre 200 y 381 en la evaluación de la totalidad del holter, y entre 201 y 384 en la evaluación durante 18 horas, mostrando la cercanía en las medidas, lo que permite que la disminución en el tiempo de la evaluación sea consistente, esta misma cercanía se observó para las dinámicas enfermas y agudas.Conclusión: Se evidenció la aplicabilidad clínica en 18 horas de la ley exponencial en la dinámica cardiaca caótica asociada a arritmias mostrando ser de utilidad para la predicción de la evolución hacia estados agudos de la dinámica.

the need for nutritional care models, to address the problem of malnutrition in hospitals, involves developing mederi Nutrition Care Model in order to raise the quality of health care, and promote good practices of Clinical Nutrition. To describe the process of nutrition and metabolic support, aimed at measuring the effectiveness of the model, which is currently a center of national and international reference.descriptive, evaluative, transversal and observational. Includes analysis of consolidated since the implementation of the model in 2008 through 2014. Information The number of study subjects was 163 575, variables to test the efficacy measures were: productivity and perceived quality of nutritional care.made analysis of the key processes in which the model is based, nutritional adult and neonatal hospital care, nutritional support, supervision of food services, and teaching and research, is an increase in productivity of the service 591% , increasing the percentage of patient satisfaction from 50% to 95.8%.the success of a model of nutritional care lies in the consolidation of administrative, healthcare facilities, which in turn promotes the development of human talent, teaching and research in nutrition.Introducción: la necesidad de modelos en atención nutricional para responder a la problemática de la malnutrición en los hospitales, conlleva desarrollar el modelo Méderi de Atención Nutricional, con el fin de elevar la calidad de la atención en salud y promover buenas prácticas de nutrición clínica. Objetivo: describir el proceso de nutrición y soporte metabólico, orientado a medir la eficacia del modelo, el cual se constituye actualmente en un centro de referencia nacional e internacional. Materiales y métodos: estudio de tipo descriptivo, evaluativo, transversal y observacional. Incluye el análisis de la información consolidada desde la implementación del modelo en el año 2008 hasta el año 2014. El número de sujetos del estudio fue de 163.575 y las variables medidas para probar la eficacia fueron: productividad y calidad percibida de la atención nutricional. Resultados: realizado el análisis de los procedimientos claves en los que se fundamenta el modelo: atención nutricional hospitalaria adulta y neonatal, soporte nutricional, interventoría a servicios de alimentación, y docencia e investigación, se encuentra un aumento en la productividad del servicio de un 591%, así como un incremento del porcentaje de satisfacción de los pacientes del 50 % al 95,8%. Conclusión: el éxito de un modelo de atención nutricional radica en la consolidación de una estructura administrativa y asistencial, que a su vez promueva el desarrollo del talento humano, la docencia y la investigación en nutrición.

Introduction Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, but at the same time lowers the incidence of complications, which translates in better patient outcomes. Objective To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. Methodology A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of these guidelines. Results Four hundred and sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. Conclusions This guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to appropriate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropriate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids. Introducción El óptimo manejo de la sedación, analgesia y delirium ofrece al paciente crítico comodidad y seguridad, facilita el buen desarrollo de medidas de soporte y manejo integral y disminuye complicaciones, impactando en un mejor desenlace. Objetivo Actualizar la Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo publicada en Medicina Intensiva en el 2007 y dar recomendaciones para el manejo de la sedación, analgesia y delirium. Metodología Se reunió un grupo de 21 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 de ellos además especialistas en epidemiología clínica y metodología para elaboración de guías. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. La fuerza de las recomendaciones fue calificada como 1=fuerte, o 2=débil, y la calidad de la evidencia como A=alta, B=moderada, o C=baja. Expertos en búsqueda de literatura apoyaron con esta estrategia de búsqueda: MEDLINE a través de PUBMED, bases de datos de la biblioteca Cochrane a través de The Cochrane Library y la base de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud. Los miembros asignados a las 11 secciones de la guía, basándose en la revisión de la literatura, presentaron las recomendaciones, sustentadas y discutidas en sesiones plenarias, aprobando aquellas que superaron el 80% del consenso. La elaboración de las guías contó con el soporte de la Asociación Colombiana de Medicina Crítica y Cuidado Intensivo. Resultados Para la elaboración de la guía fueron finalmente seleccionadas 467 referencias, observándose un importante aumento en el número y calidad de los estudios, permitiendo realizar 64 fuertes recomendaciones con evidencia alta y moderada, contrastando con las 28 de la edición anterior. Conclusiones Esta guía contiene recomendaciones y sugerencias basadas en la mejor evidencia para el manejo de la sedación, analgesia y delirium del paciente crítico, incluyendo un paquete de medidas (bundle). Se destacan: evaluación del dolor y la agitación/sedación mediante escalas; usar inicialmente opioides para el control de la analgesia, adicionando técnicas multimodales para disminuir consumo de opioides; promover el menor nivel de sedación necesario, evitando la sobresedación; en caso de requerir medicamentos sedantes, escoger el más apropiado, evitando el uso rutinario de benzodiazepinas; por último, identificar factores de riesgo para delirium, prevenirlo, diagnosticarlo y manejarlo, con el medicamento más conveniente, ya sea haloperidol, antipsicóticos atípicos o dexmedetomidina, evitando el uso de benzodiazepinas y disminuyendo el uso de opioides.

La dinámica cardíaca caracterizada en el contexto de la teoría de sistemas dinámicos permite diferenciar y predecir estados cardíacos normales, diferentes niveles de enfermedad, así como la evolución hacia la enfermedad. El propósito de este estudio es aplicar una metodología desarrollada previamente a 450 registros electrocardiográficos para establecer su efectividad y compararla con el diagnóstico clínico convencional. La metodología se aplicó a 50 Holters normales y 400 Holters con diferentes patologías. Luego de enmascarar las conclusiones diagnósticas, se utilizó la frecuencia cardíaca mínima y máxima y el número total de latidos cada hora para construir un atractor para cada Holter en un espacio de fase, mediante el cual se evaluó la probabilidad, entropía y sus proporciones en pares ordenados. de frecuencia cardíaca. Se compararon las medidas con los parámetros físicos y matemáticos de normalidad y enfermedad previamente establecidos. Se desenmascararon las conclusiones diagnósticas y las fechas de la historia clínica de cada Holter, para calcular la sensibilidad, especificidad y coeficiente Kappa respecto al Gold-standard. Esta metodología permitió diferenciar matemáticamente la dinámica de la enfermedad normal, aguda y crónica y la evolución entre estos estados. Se obtuvo una sensibilidad y especificidad del 100% y el coeficiente Kappa fue igual a 1, demostrando su utilidad diagnóstica. Heart dynamic characterized within the context of dynamical systems theory allows differentiating and predicting normal cardiac states, different levels of disease, as well as evolution towards disease. The purpose of this study is to apply a previously developed methodology to 450 electrocardiographic registers to establish its effectiveness and comparing it with clinical conventional diagnosis. The methodology was applied to 50 normal Holters and 400 Holters with different pathologies. After masking the diagnostic conclusions, the minimum and maximum heart rate and the total number of beats each hour were used to construct an attractor for each Holter in a phase space, by means of which the probability, entropy and their proportions were evaluated in ordered pairs of heart rate. Measures were compared with the physical and mathematical parameters of normality and disease previously settled down. Diagnostic conclusions and dates from medical history of each Holter were unmasked, to calculate sensibility, specificity and coefficient Kappa respect to Gold-standard. This methodology allowed mathematically differentiating the normal, acute and chronic disease dynamics and the evolution among these states. Sensibility and specificity of 100% were obtained and Kappa coefficient was equal to 1, demonstrating its diagnostic utility.

El manejo con ventilación mecánica no invasiva (VMNI) en las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) reduce la necesidad de intubación y las complicaciones asociadas. Por tanto, está indicado en situaciones clínicas de insuficiencia respiratoria aguda. Las variables gasométricas descritas a nivel del mar no son aplicables a la altitud de Bogotá, Colombia (2.640 metros sobre el nivel del mar). El objetivo fue cuantificar la frecuencia de falla de la VMNI (definida como muerte, intubación o traqueotomía) y describir las variables al ingreso asociadas a falla en pacientes con exacerbación de EPOC e insuficiencia respiratoria que requieren manejo en la unidad de cuidados intensivos (UCI). ). MÉTODOS: se analizó una cohorte retrospectiva; Se registraron características clínicas, puntuaciones de gravedad y valores gasométricos. Se evaluaron las diferencias entre los grupos de éxito y fracaso. Se aplicó un análisis de regresión logística para explorar los factores asociados con el resultado. RESULTADOS: Se incluyeron 158 pacientes; 54,5% eran mujeres; la edad media fue de 74,3 ± 8,8 años. Características al ingreso: APACHE 17,1 ± 4,1, PaCO2 52,7 ± 14,9 mm Hg, PaO2 / FIO2 166,6 ± 61,1, pH 7,32 ± 0,09, FC 104,4 ± 23 , 1. Manejo con BiPAP: 93%, CPAP: 7%. La VMNI falló en el 24,1% (intubación orotraqueal: 15,8%, traqueotomía: 6,3% y mortalidad: 12%). En el análisis multivariado, las variables asociadas con el fracaso fueron: APACHE ?17 (OR: 2,34 [1,04-5,3]) y PaCO2 ?55 (OR: 2,47 [1,08-5,79]) . No hubo asociación con el sexo o PaO2 / FIO2. CONCLUSIONES: el porcentaje de fracaso con VMNI (24,1%) fue menor al reportado en la literatura internacional. Los factores de riesgo encontrados (APACHE y PaCO2 altos) se confirman como predictores de falla en VMNI, y son aplicables a Bogotá o altitudes similares. Las grandes altitudes no parecen tener influencia en los resultados de los pacientes con exacerbaciones de la EPOC que requieren tratamiento en una UCI. Management with non-invasive mechanical ventilation (NIMV) in exacerbations of chronic obstructive pulmonary disease (COPD) reduces the need for intubation and the associated complications. It is therefore indicated in clinical settings of acute respiratory failure. The gasometric variables described at sea level are not applicable at the altitude of Bogotá, Colombia (2.640 meters above sea level). The objective was to quantify the frequency of failure of NIMV (defined as death, intubation, or tracheostomy) and to describe the variables at admission associated with failure in patients with exacerbation of COPD and respiratory failure that require management in the intensive care unit (ICU). METHODS: a retrospective cohort was analyzed; clinical characteristics, severity scores, and gasometric values were registered. The differences between the success and failure groups were evaluated. A logistic regression analysis was applied to explore factors associated with outcome. RESULTS: 158 patients were included; 54,5% were women; the mean age was 74,3±8,8 years. Characteristics at admission: APACHE 17,1±4,1, PaCO2 52,7±14,9 mm Hg, PaO2 /FIO2 166,6±61,1, pH 7,32±0,09, FC 104,4±23,1. Management with BiPAP: 93%, CPAP: 7%. NIMV failed in 24,1% (orotracheal intubation: 15,8%, tracheostomy: 6,3%, and mortality: 12%). On multivariate analysis, the variables associated with failure were: APACHE ?17 (OR: 2,34 [1,04-5,3]) and PaCO2 ?55 (OR: 2,47 [1,08-5,79]). There was no association with sex or PaO2 /FIO2 . CONCLUSIONS: the percentage of failure with NIMV (24,1%) was less than that reported in the international literature. The risk factors found (high APACHE and PaCO2 ) are confirmed as predictors of failure in NIMV, and are applicable to Bogotá or similar altitudes. High altitudes do not appear to have influence on the outcomes of patients with COPD exacerbations that require management in an ICU.

International audience; BACKGROUND: The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin. METHODS: In a double-blind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at increased risk for stroke to receive either rivaroxaban (at a daily dose of 20 mg) or dose-adjusted warfarin. The per-protocol, as-treated primary analysis was designed to determine whether rivaroxaban was noninferior to warfarin for the primary end point of stroke or systemic embolism. RESULTS: In the primary analysis, the primary end point occurred in 188 patients in the rivaroxaban group (1.7% per year) and in 241 in the warfarin group (2.2% per year) (hazard ratio in the rivaroxaban group, 0.79; 95% confidence interval [CI], 0.66 to 0.96; P

Se presentan las imágenes escanograficas de un caso de tuberculosis traqueal

La nocardiosis es una rara infección oportunista que afecta principalmente a pacientes con alteración de la inmunidad celular, como pacientes con síndrome de inmunodeficiencia adquirida o postrasplantes. El compromiso del sistema nervioso central es generalmente como absceso y menos frecuentemente como meningitis primaria. El presente artículo hace el reporte de un caso de meningitis primaria por Nocardia en paciente inmunocompetente y revisión de la literatura. Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. The central nervous system presentation is as cerebral abscesses and less frequently, as primary meningitis. Here, a case of primary nocardia meningitis is described in a patient without a predisposing condition, along with a literature review. © 2014 ACIN. Published by Elsevier España, S.L.U. All rights reserved.

Hombre de 25 años, quien posterior a trasplante de medula ósea presenta fiebre. En la TC se evidencian nódulos pulmonares con densidad de tejidos blandos, rodeados por un halo de “vidrio esmerilado”, que corresponden histológicamente a un área de necrosis con compromiso vascular por Aspergillus fumigatus (flecha verde), e infiltración eosinofílica intersticial (flecha amarilla). El signo del halo es definido por la Sociedad Fleischner como una opacidad en vidrio esmerilado que rodea un nódulo pulmonar o una masa. Fue descrito por Janet Kuhlman en dos pacientes con aspergilosis pulmonar.

Paciente de 48 años con cuadro de un mes de dolor torácico, tos con expectoración purulenta y fiebre. Remitido para manejo con diagnóstico de absceso pulmonar. La TC de tórax contrastada demostró masa pulmonar cavitada (Figura 1) y oclusión de la arteria interlobar derecha (Figura 2), que confirmó el diagnóstico de infarto pulmonar. Se define masa pulmonar como una opacidad parenquimatosa con diámetro mayor de 3 cm, independiente de las características de sus contornos, bordes y densidad. El término de cavitación se refiere a la presencia de áreas de menor densidad (líquido-aire) dentro de un nódulo, una masa o consolidación del parénquima pulmonar. El diagnóstico diferencial de masa pulmonar cavitada es amplio e incluye entidades congénitas (secuestro pulmonar, quiste broncogénico), infecciosas (absceso pulmonar bacteriano, actinomicosis, tuberculosis, aspergilosis, mucormicosis), neoplásicas (carcinoma broncogénico, metástasis, linfoma), vasculares (infarto pulmonar), inmunológicas (poliangeítis con granulomatosis, granulomatosis eosinofílica con poliangeítis) y misceláneas (amiloidosis). 48-year-old patient with a one-month picture of chest pain, cough with purulent expectoration and fever. Referred for management with diagnosis of lung abscess. Contrast-enhanced chest CT demonstrated cavitated lung mass (Figure 1) and occlusion of the right interlobar artery (Figure 2), which confirmed the diagnosis of pulmonary infarction. Pulmonary mass is defined as a parenchymal opacity with a diameter greater than 3 cm, independent of the characteristics of its contours, edges and density. The term cavitation refers to the presence of areas of lower density (liquid-air) within a nodule, a mass, or consolidation of the lung parenchyma. The differential diagnosis of cavitated lung mass is wide and includes congenital entities (lung sequestration, bronchogenic cyst), infectious (bacterial lung abscess, actinomycosis, tuberculosis, aspergillosis, mucormycosis), neoplastic (bronchogenic carcinoma, metastasis, lymphoma), vascular (pulmonary infarction) ), immunological (polyangiitis with granulomatosis, eosinophilic granulomatosis with polyangiitis) and miscellaneous (amyloidosis).

Introducción: la necesidad de modelos en atención nutricional para responder a la problemática de la malnutrición en los hospitales, conlleva desarrollar el modelo Méderi de Atención Nutricional, con el fin de elevar la calidad de la atención en salud y promover buenas prácticas de nutrición clínica. Objetivo: describir el proceso de nutrición y soporte metabólico, orientado a medir la eficacia del modelo, el cual se constituye actualmente en un centro de referencia nacional e internacional. Materiales y métodos: estudio de tipo descriptivo, evaluativo, transversal y observacional. Incluye el análisis de la información consolidada desde la implementación del modelo en el año 2008 hasta el año 2014. El número de sujetos del estudio fue de 163.575 y las variables medidas para probar la eficacia fueron: productividad y calidad percibida de la atención nutricional. Resultados: realizado el análisis de los procedimientos claves en los que se fundamenta el modelo: atención nutricional hospitalaria adulta y neonatal, soporte nutricional, interventoría a servicios de alimentación, y docencia e investigación, se encuentra un aumento en la productividad del servicio de un 591%, así como un incremento del porcentaje de satisfacción de los pacientes del 50 % al 95,8%. Conclusión: el éxito de un modelo de atención nutricional radica en la consolidación de una estructura administrativa y asistencial, que a su vez promueva el desarrollo del talento humano, la docencia y la investigación en nutrición.