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Objetivo: Verificar la asociación del ángulo de fase con el estado nutricional, la duración de la estancia hospitalaria y la muerte en pacientes críticos. Métodos: estudio longitudinal con 57 pacientes críticos evaluados al ingreso en la unidad de cuidados intensivos durante el año 2019, en el interior de São Paulo - BR. El ángulo de fase se obtuvo mediante bioimpedancia eléctrica, y la valoración nutricional, mediante el instrumento de valoración subjetiva global y la antropometría. Los datos se asociaron al momento de la hospitalización y a la muerte. Para el análisis se utilizaron las pruebas de Mann-Whitney y Chi-cuadrado de Pearson. Resultados: en la evaluación subjetiva global, el 59,6% de los pacientes presentó riesgo nutricional, y en el 91,2% el ángulo de fase fue bajo. La desnutrición se asoció a una mayor estancia hospitalaria (p=0,001) en la unidad de cuidados intensivos (p=0,023). Hubo una tendencia a la muerte en el grupo con riesgo nutricional (p=0,054). Conclusión: el ángulo de fase puede contribuir a una mayor precisión en la evaluación nutricional, especialmente cuando se combina con otros métodos de evaluación.

Introduction: Spontaneous intracerebral hematoma is the form of stroke with the highest mortality and morbidity rates. There is no consensus as to which patients benefit from surgical evacuation of the hematoma and, furthermore, postoperative mortality is high in most series. Objective: To create a prognostic index of postoperative mortality for patients with intracerebral hematoma treated by craniotomy and hematoma evacuation. Methods: An observational, prospective study of 116 patients with intracerebral hematoma treated surgically was carried out. Preoperative factors related to postoperative mortality were identified. The identified prognostic factors were combined in an index to estimate its predictive capacity, and this capacity was verified in a different sample. Results: Age ≥ 60 years, Glasgow Coma Scale score ≤ 10 points, and hematoma depth ≥ 1.25 cm are independent predictors of postoperative mortality. The area under the curve for the probability of dying calculated by the logistic regression model in the estimation sample was 0.953 (CI: 0.905-1.000). The proposed postoperative mortality prognostic index classifies patients as low, intermediate, high risk and very high risk of death. Conclusions: The proposed prognostic index correctly predicts postoperative mortality in patients with intracerebral hematoma treated by craniotomy and evacuation of the hematoma.

Objectives: To identify predictors for developing delayed neurological syndrome (DNS) after an initial episode of carbon monoxide (CO) poisoning in the interest of detecting patients most likely to develop DNS so that they can be followed., Material and Methods: Retrospective review of cases of CO poisoning treated in the past 10 years in the emergency departments of 4 hospitals in the AMICO study (Spanish acronym for the multicenter analysis of CO poisoning). We analyzed demographic characteristics of the patients and the clinical characteristics of the initial episode. The records of the cohort of patients with available follow-up information were reviewed to find cases of DNS. Data were analyzed by multivariant analysis to determine the relationship to characteristics of the initial exposure to CO., Results: A total of 240 cases were identified. The median (interquartile range) age of the patients was 36.2 years (17.6-49.6 years); 108 patients (45.0%) were men, and the poisoning was accidental in 223 cases (92.9%). The median carboxyhemoglobin concentration on presentation was 12.7% (6.2%-18.7%). Follow-up details were available for 44 patients (18.3%). Eleven of those patients (25%) developed DNS. A low initial Glasgow Coma Scale score predicted the development of DNS with an odds ratio (OR) of 0.61 (95% CI, 0.41-0.92) and an area under the receiver operating characteristic curve of 0.876 (95% CI, 0.761-0.990) (P .001)., Conclusion: The initial Glasgow Coma Scale score seems to be a clinical predictor of DNS after CO poisoning. We consider it important to establish follow-up protocols for patients with CO poisoning treated in hospital EDs.

Mejorar el conocimiento de la Irradiancia Solar (IS) sobre la superficie terrestre, así como su predicción (pronóstico), cobra especial interés por su importancia para las energías renovables, a como lo son los sistemas basados en Energía Solar (ES), y para distintas aplicaciones industriales o ecológicas. En la presente investigación se ha experimentado con cinco técnicas de estimación espacial de la IS a intervalos de 15 minutos, en el territorio peninsular español, con distintas configuraciones espaciales. Encontrándose que la geoestadística mediante el Kriging con Regresión, usando variables auxiliares -una de ellas la IS estimada a partir de imágenes satelitales- permite estimar espacialmente la IS más allá de los 25 km, identificados en las investigación científicas previas, como límite de distancia máxima al punto de estimación. Se ha experimentado con el modelado de Redes Neuronales Artificiales (RNA) para la predicción en tiempo futuro (temporal) -a corto plazo- de la IS utilizando observaciones próximas (componentes espaciales) en sus entradas y los resultados son prometedores. Así los niveles de errores disminuyen, en relación a investigaciones relacionadas, bajo las siguientes condiciones: cuando el horizonte temporal de predicción es inferior o igual a 3 horas, las estaciones vecinas que se incluyen en los modelos deben encentrarse a una distancia máxima aproximada de 55 km.

Today he prices of the petroleum exhibit a tendency to drop with negative effects for the economy of the countries exporters of raw. Anticipating the economic variables behavior improve the taking of decisions since it mitigate the uncertainty. The model Autorregresive Integrated and Moving Average (ARIMA) describes the behavior of a series of time like a function of the precedent observations and the stochastic interferences. The present article has as objective to carry out a forecast of the behavior of the prices of the petroleum for the year 2017, using an ARIMA model. The work use a daily prices time series of the Brent petroleum (to the closing of the market) that concerns to the period between 29/3/2016 up to 6/4/2017.

Introducción. La hemoptisis es una de las manifestaciones más alarmantes de las enfermedades broncopulmonares y representa el 7% de los ingresos hospitalarios a los servicios de medicina Interna. La hemoptisis severa está relacionada a cifras altas de mortalidad alrededor del 40%. Existen múltiples factores que cuando coexisten con hemoptisis alteran su evolución y pronóstico. No solo la severidad de la hemoptisis determina el riesgo de muerte, sino la presencia de comorbilidades, especialmente pulmonares que afectan la reserva funcional del paciente. Objetivos. Determinar la mortalidad y los factores que incrementan la mortalidad en pacientes con hemoptisis que son admitidos por un servicio de emergencia. Diseño. Estudio analítico. Institución. Servicio de emergencia, Hospital Nacional Dos de Mayo, Lima, Perú. Participantes. Pacientes con diagnóstico de hemoptisis. Métodos. Se revisaron 108 historias clínicas de pacientes que fueron hospitalizados por emergencia con diagnóstico de hemoptisis en un lapso de 2 años. Se recolectaron las variables edad, sexo, procedencia, presencia de comorbilidades, reserva funcional respiratoria cualitativa, entre otros. Los resultados se expresaron en distribución de frecuencias absolutas y relativas, medias (+1DE); los factores relacionados a incremento de mortalidad se les determinó mediante el estimado del riesgo relativo (RR). Para la comparación de proporciones se utilizó la prueba chi2. Para determinar las variables asociadas a mortalidad se usó el modelo de regresión logística múltiple. Principales medidas de resultados. Factores asociados a incremento de mortalidad. Resultados. Los factores asociados a incremento de mortalidad fueron la presencia de caverna mayor de 1 cm de diámetro, de localización hiliar, y el antecedente de readmisiones por hemoptisis. Así mismo, la presencia de fibrosis pulmonar que comprometía más de 50% del parénquima pulmonar bilateral fue importante predictor de mortalidad. Conclusiones. La reserva funcional pulmonar fue el determinante principal relacionado a mortalidad en pacientes con hemoptisis que fueron hospitalizados por emergencia.

Objectives: To study baseline factors associated with hypo- and hypernatremia in older patients attended in emergency departments (EDs) and explore the association between these dysnatremias and indicators of severity in an emergency., Material and Methods: We included patients attended in 52 Spanish hospital EDs aged 65 years or older during a designated week. All included patients had to have a plasma sodium concentration on record. Patients were distributed in 3 groups according to sodium levels: normal, 135-145 mmol/L; hyponatremia, 135 mmol/L; or hypernatremia > 145 mmol/L. We analyzed associations between sodium concentration and 24 variables (sociodemographic information, measures of comorbidity and baseline functional status, and ongoing treatment for hypo- or hypernatremia). Indicators of the severity in emergencies were need for hospitalization, in-hospital mortality, prolonged ED stay (> 12 hours) in discharged patients, and prolonged hospital stay (> 7 days) in admitted patients. We used restricted cubic spline curves to analyze the associations between sodium concentration and severity indicators, using 140 mmol/L as the reference., Results: A total of 13 368 patients were included. Hyponatremia was diagnosed in 13.5% and hypernatremia in 2.9%. Hyponatremia was associated with age ($ 80 years), hypertension, diabetes mellitus, an active neoplasm, chronic liver disease, dementia, chemotherapy, and needing help to walk. Hypernatremia was associated with needing help to walk and dementia. The percentages of cases with severity indicators were as follows: hospital admission, 40.8%; in-hospital mortality, 4.3%; prolonged ED stay, 15.9%; and prolonged hospital stay, 49.8%. Odds ratios revealed associations between lower sodium concentration cut points in patients with hyponatremia and increasing need for hospitalization (130 mmol/L, 2.24 [IC 95%, 2.00-2.52]; 120 mmol/L, 4.13 [3.08-5.56]; and 110 mmol/L, 7.61 [4.53-12.8]); risk for in-hospital death (130 mmol/L, 3.07 [2.40-3.92]; 120 mmol/L, 6.34 [4.22- 9.53]; and 110 mmol/L, 13.1 [6.53-26.3]); and risk for prolonged ED stay (130 mmol/L, 1.59 [1.30-1.95]; 120 mmol/L, 2.77 [1.69-4.56]; and 110 mmol/L, 4.83 [2.03-11.5]). Higher sodium levels in patients with hypernatremia were associated with increasing need for hospitalization (150 mmol/L, 1.94 [1.61-2.34]; 160 mmol/L, 4.45 [2.88-6.87]; 170 mmol/L, 10.2 [5.1-20.3]; and 180 mmol/L, 23.3 [9.03-60.3]); risk for in-hospital death (150 mmol/L, 2.77 [2.16-3.55]; 160 mmol/L, 6.33 [4.11-9.75]; 170 mmol/L, 14.5 [7.45-28.1]; and 180 mmol/L, 33.1 [13.3-82.3]); and risk for prolonged ED stay (150 mmol/L, 2.03 [1.48-2.79]; 160 mmol/L, 4.23 [2.03-8.84]; 170 mmol/L, 8.83 [2.74-28.4]; and 180 mmol/L, 18.4 [3.69-91.7]). We found no association between either type of dysnatremia and prolonged hospital stay., Conclusion: Measurement of sodium plasma concentration in older patients in the ED can identify hypo- and hypernatremia, which are associated with higher risk for hospitalization, death, and prolonged ED stays regardless of the condition that gave rise to the dysnatremia.

El delta del río Paraná es un ecosistema de alta fragilidad ambiental y muy susceptible a las inundaciones. A su vez, se caracteriza por tener una importante actividad económica, social y productiva. Disponer de una cartografía de susceptibilidad hídrica en la región es una herramienta útil para la toma de decisiones en los sectores agropecuario y forestal. Además de los pronósticos de caudales, es importante contar con una estimación de la distribución espacial de los derrames según el escenario hidrológico previsto que puede fluctuar entre muy seco (aguas muy bajas) y muy húmedo (aguas muy altas). Mediante el procesamiento y clasificación de imágenes satelitales de alta resolución correspondientes a la serie temporal 1980-2010 se generó un mapa de susceptibilidad hídrica en el tramo medio del delta Paranaense. El empleo de esta información superpuesta con las cartas topográficas de la zona permitirá al productor agropecuario, a través de la ubicación por coordenadas geográficas, tener conocimiento del grado de afectación por el agua que tendrá un área determinada.

Objectives: Patients with implantable cardioverter defibrillators (ICDs) are at risk of serious complications that are often treated in hospital emergency departments (EDs). The EMERG-ICD study (Emergency Department Management and Long-term Prognosis for Patients with ICDs) analysed management and long-term prognosis of ED patients with an ICD after an acute clinical event., Material and Methods: Observational multicenter cohort study including consecutive adult patients with ICDs who came to 27 hospital EDs in Spain for treatment and were followed for 10 years. We collected clinical variables on presentation, ED case management variables, and the date and cause of death in each case. The primary outcome variable was all-cause mortality., Results: Five-hundred three patients were studied; 471 had structural heart disease (SHD) and 32 had primary electrical heart disease (PEHD). Beta-blockers were prescribed in the ED for 55% of the patients for whom they were indicated. Twenty-four (4.8%), 75 (15.7%), and 368 (73.2%) patients died during follow-up at 1 month, 1 year, and 10 years, respectively. Of these, 363 (77.1%) had SHD and 5 (15.6%) had PEHD (hazard ratio, 8.05 (95% CI, 3.33- 19.46). Among patients with SHD, the cause of death was cardiovascular in 66%. Mortality correlated significantly with seeking care for cardiovascular symptoms, advanced age, male sex, diabetes, a New York Heart Association score of 2 or more, severe ventricular dysfunction, and long-term amiodarone therapy., Conclusion: Prognosis after an acute clinical event is poor in patients with SHD and ICDs, mainly due to cardiovascular causes, especially among patients with associated comorbidities and cardiovascular complaints. Mortality is lower in patients with PEHD.

Objectives: Patients with severe or potentially severe trauma must be identified early, a challenge in prehospital settings. This study aimed to analyze the possible diagnostic and prognostic usefulness of analytical markers recorded in the early moments of care., Material and Methods: Observational study of information extracted from the prospective multicenter Code Trauma database for 2016-2019, excluding data for isolated head injuries. Using the New Injury Severity Score (NISS), we classified cases into 4 levels of severity. NISS and mortality were considered the dependent variables in inferential analyses. We calculated the areas under receiver operating characteristic curves, identified optimal cutoff points (Youden index), and calculated positive (PPV) and negative predictive values.., Results: Of the 1039 trauma patients in the registry, 709 were included in the study. Their mean (SD) age was 40.4 (17.3) years, and 77.3% were men. Motorcycle accidents were the most common causes of trauma (in 21%), and mortality was 12.1%. Lactate concentration, pH, PCO2, hemoglobin concentration, hematocrit, and blood sugar were significantly associated with severity and mortality. The PPVs corresponding to pH for the 4 NISS score groups (34-41, 42-49, 50-59, and $ 60) and mortality, respectively, were 61.2, 64.1, 70.7, 62.2, and 66.6. The PPVs of traditionally used clinical variables were lower., Conclusion: Patients with more severe trauma had lower pH values and higher PCO2, lactate, and base excess values. PCO2, pH, and blood sugar findings were the best predictors of severity. Metabolic variables are better predictors than traditionally recorded hemodynamic variables.

Text: The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physiciansreviewed and analyzed the 2021 SSC guidelines from our specialty's point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians' experience- and evidence-based proposals. Secondarily, the review's recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis.

Objectives: To characterize phenotypes of prehospital patients with COVID-19 to facilitate early identification of at-risk groups., Material and Methods: Multicenter observational noninterventional study of a retrospective cohort of 3789 patients, analyzing 52 prehospital variables. The main outcomes were 4 clusters of prehospital variables describing the phenotypes. Secondary outcomes were hospitalization, mechanical ventilation, admission to an intensive care unit, and cumulative mortality inside or outside the hospital on days 1, 2, 3, 7, 14, 21, and 28 after hospitalization and after start of prehospital care., Results: We used a principal components multiple correspondence analysis (factor analysis) followed by decomposition into 4 clusters as follows: cluster 1, 1090 patients (28.7%); cluster 2, 1420 (37.4%); cluster 3, 250 (6.6%), and cluster 4, 1029 (27.1%). Cluster 4 was comprised of the oldest patients and had the highest frequencies of residence in group facilities and low arterial oxygen saturation. This group also had the highest mortality (44.8% at 28 days). Cluster 1 was comprised of the youngest patients and had the highest frequencies of smoking, fever, and requirement for mechanical ventilation. This group had the most favorable prognosis and the lowest mortality., Conclusion: Patients with COVID-19 evaluated by emergency medical responders and transferred to hospital emergency departments can be classified into 4 phenotypes with different clinical, therapeutic, and prognostic characteristics. The phenotypes can help health care professionals to quickly assess a patient's future risk, thus informing clinical decisions.

El dengue es la arbovirosis de mayor incidencia mundial y una importante causa de morbilidad y mortalidad. Debido a que la enfermedad se presenta en principio como un cuadro febril inespecífico, se requieren herramientas que permitan reconocer y clasificar a los pacientes con dengue en forma temprana. Un parámetro de utilidad en este sentido puede ser la presencia de linfocitos atípicos. Objetivo: revisar los resultados de los trabajos originales existentes en la literatura sobre linfocitos atípicos e infección por virus dengue y su papel en el diagnóstico y pronóstico de la enfermedad. Materiales y métodos: para la revisión se emplearon los motores de búsqueda PubMed y Lilacs, bajo la combinación de términos Dengue AND Atypical lymphocyte (OR Reactive lymphocyte, OR Turk cell), limitando los hallazgos a estudios en humanos. La información obtenida fue clasificada por su contenido. Solo se incluyeron en el presente trabajo los estudios relevantes para el tema. Resultados: se ajustaron 68 referencias a la estrategia de búsqueda empleada, pero solo doce correspondían al objeto de la revisión. Todos los estudios incluidos reportaron presencia de linfocitos atípicos como hallazgo hematológico particular en pacientes con dengue y aunque no fue un hallazgo específico de la enfermedad, su concentración fue significativamente superior en estos pacientes, sobre todo en cuadros severos de la misma. Conclusiones: de acuerdo con la evidencia encontrada, puede considerarse que existe una asociación entre la presencia de linfocitos atípicos y la infección por el virus dengue; sin embargo, la intensidad y utilidad de este hallazgo requiere mayor estudio y análisis.

El presente trabajo tiene como objetivo evaluar el pronóstico de precipitaciones realizado por el modelo tridimensional de microfísica parametrizada ARPS (Advanced Regional Prediction System), el cual se utilizó en la Campaña de Incremento Artificial de la Lluvia en el Occidente de Cuba, del 23 de agosto de al 3 de octubre de 2011. El enfoque de evaluación seleccionado fue el espacial, con la metodología orientada a objetos. Como método para la identificación de los objetos se utilizó el detector de bordes de Canny, que suaviza la imagen original mediante una convolución Gaussiana; luego, al campo suavizado se le aplicó el operador de Sobel con énfasis en las regiones de frecuencias espaciales altas, y para agruparlas se utilizó la envoltura convexa con el algoritmo QuickHull (Bradford et al., 1996). Entre los resultados principales se obtuvo que las simulaciones realizadas representan correctamente las características de los sistemas convectivos que provocaron la precipitación, como son las líneas de convección organizada, los conglomerados nubosos y las formaciones de celdas simples. Además, los horarios comprendidos entre las 1600 horas y las 1700 horas resultaron los de mayor correspondencia entre las áreas calculadas, y mostraron mayor similitud en los cuadrantes I y II. El modelo pronosticó bien las áreas de precipitaciones, aunque en varias ocasiones experimentó cierto desfasaje en el momento de ocurrencia de estas, que osciló entre 30 min y 3 h, y un desplazamiento del área, en general, hacia el sur de la zona real observada.

Objectives: To evaluate lactate, procalcitonin, criteria defining systemic inflammatory response syndrome (SIRS), and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality, infection with microbiologic confirmation, and true bacteremia in patients treated for infection in hospital emergency departments., Material and Methods: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish emergency departments from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and predetermined decision points were assessed., Results: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. True bacteremia was detected in 899 (20.25%), and microbiologic confirmation was on record for 2057 (46.3%). The model that included the qSOFA score (2) and lactate concentration (0.738 mmol/L; 95% CI, 0.711-0.765 mmol/L) proved to be the best predictor of 30-day mortality, with an AUC of 0.890 (95% CI, 0.880-0.901). The model that included the SIRS score (2) and procalcitonin concentration (0.51 ng/mL) proved to be the best predictor of true bacteremia and microbiologic confirmation, with an AUC of 0.713 (95% CI, 0.698-0.728)., Conclusion: A qSOFA score of 2 or more plus lactate concentration (0.738 mmol/L) predict 30-day mortality better than the combination of a SIRS score of 2 or more and procalcitonin concentration. A SIRS score of 2 or more plus procalcitonin concentration (0.51 ng/mL) predict true bacteremia and microbiologic confirmation.

Este documento presenta la estimación de la demanda trimestral por emisión monetaria mediante tres técnicas estadísticas, a saber: mínimos cuadrados ordinarios, corrección de errores y vectores autorregresivos. La estimación de la demanda se realizó para el periodo 1987–1997. En general las ecuaciones estimadas presentaron resultados satisfactorios en términos económicos y estadísticos. La capacidad de predicción se verificó con los bajos errores de pronóstico, inferiores al 3% para 1997. Se comprobó la estabilidad de la demanda de corto y largo plazo mediante los estadísticos Cusum y Cusum-Cuadrado, así como con la prueba de cointegración de Johansen.