Nutritional state, immunological and biochemical parameters, and mortality in the ICU: an analytical study

Intensive care unit (ICU) hospitalization involves critically ill patients with multiple diseases and possible complications, including malnutrition, which increases hospital stay and mortality. Therefore, identifying the patient’s prior nutritional state, following up during hospitalization, and implementing early intervention positively affect patient’s vital situations at discharge. The objective of this study is to determine the nutritional state of patients admitted to an ICU in Cali (Colombia) in 2019 and its association with immunological and biochemical parameters and mortality observed during hospitalization. This was an observational, analytical, and retrospective study of patients admitted to an ICU in a clinic in Cali (Colombia) from 1 January to 31 March 2019. The association between their nutritional state and outcome variables such as hospital stay, immunological and biochemical function, and mortality was analyzed. Logistic regression was used to predict patients’ vital status at hospital discharge. In terms of the nutritional level, low weight was observed in 17.5% patients, and overweight/obesity was observed in 53.5% of the population. Nutritional state was associated with leukocytosis. The patients with lymphocytosis had longer hospital stays than those with normal lymphocyte ranges. Age, blood leukocytes, and creatinine and potassium levels increased the risk of mortality. Lymphocyte values have been used as predictors of severity and hospitalization time. The scientific literature has also evidenced a higher leukocyte count in people with obesity, and such leukocytosis is associated with the risk of mortality. The results of blood and laboratory tests determining kidney function and blood electrolytes allow for the prediction of mortality risk in critically ill patients

CAMBIOS DE LA CÓRNEA EN PACIENTES CON CIRUGÍA DE CATARATAS MÁS IMPLANTE DE LENTE INTRAOCULAR Y CIRUGÍA REFRACTIVA PREVIA: UNA REVISIÓN EXPLORATORIA

Introduction: Optical aberrations are imperfections of an optical system that produce defective images and prevent the reproduction of a clear and exact copy of the fixation object. Objective: Synthesize the available evidence on changes in post cataract surgery with intraocular lens implantation and previous refractive surgery. Methodology: an exploratory literature review of observational studies was carried out in order to identify, characterize and summarize the available evidence on the prevalence of changes in the cornea after cataract surgery with intraocular implant and previous refractive surgery. Results: 9 studies were selected that added a total of 402 users intervening 608 eyes, that is, an average of 1.51 eyes per patient, the average age was 51 ± 19.4 years, with a higher frequency of women, use of standard intraocular lens, acri.smart and colamer, phacoemulsification surgery and micro incision (MICS), finding greater change in third order aberrations especially trefoil. Conclusion: the results of the body of evidence showed that a surgery with an incision equal to or less than 2.0 mm induces slight changes in the aberration of the total cornea and better optical results in the patient, including shorter recovery time and patient satisfaction. In addition, the location of the incision plays an important role in the change of corneal aberrations.Introducción: Las aberraciones ópticas son imperfecciones de un sistema óptico que producen imágenes defectuosas e impiden reproducir una copia clara y exacta del objeto de fijación. Objetivo: Sintetizar la evidencia disponible sobre los cambios en la post cirugía de catarata con implante de lente intraocular y cirugía refractiva previa. Metodología: se realizó una revisión exploratoria de literatura de estudios observacionales, con el fin de identificar, caracterizar y resumir la evidencia disponible sobre la prevalencia de cambios en la córnea post cirugía de catarata con implante intraocular y cirugía refractiva previa. Resultados: fueron seleccionados 9 estudios que sumaron un total de 402 usuarios interviniendo 608 ojos, es decir una media de 1,51 ojos por paciente, el promedio de edad fue de 51 ± 19,4 años, con mayor frecuencia de mujeres, uso de lente intraocular estándar, acri.smart y colamer, cirugía por facoemulsificación y la micro incisión (MICS), encontrando mayor cambio en las aberraciones de tercer orden especialmente la trefoil. Conclusión: los resultados del cuerpo de la evidencia mostraron que una cirugía con una incisión igual o menor a los 2.0 mm induce a cambios leves en la aberración de la córnea total y mejores resultados ópticos en el paciente incluyendo menor tiempo de recuperación y satisfacción del paciente, además la ubicación de la incisión juega un papel importante en el cambio de las aberraciones corneales

Relación entre la distancia recorrida en el test de caminata, disnea y calidad de vida en pacientes con EPOC

Chronic Obstructive Pulmonary Disease (COPD) is characterized by various signs and symptoms that limit the performance of activities of daily life and affect aerobic capacity, and could also influence health-related quality of life (HRQoL). The objective of the present study was to determine the relationship between aerobic capacity, dyspnea and quality of life in COPD patients who attend a pulmonary rehabilitation (PR) program. Descriptive study, with a cross-sectional correlational design in patients with COPD; with the ability to perform the six-minute walk test (6MWT) and answer the SGRQ and CRQ-SAS quality of life questionnaires. 36 patients, mean age 71.9 ± 7.1; mostly men with 83.3%. When correlating the 6MT and dyspnea, mMRC p-value = 0.00 and r = -0.586. In turn, a p-value <0.05 was obtained in the CRQ questionnaire; emotional, fatigue and total domains. The distance traveled on the (6MT) and dyspnea correlate with HRQL in the fatigue, choking and emotional domains of the CRQ questionnaire. No correlations were presented for the SGRQ questionnaire; however, the activities domain has a higher score. In conclusion, the domains of the CRQ questionnaire show a better correlation with the aerobic capacity of patients with COPD.La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por diversos signos y síntomas que limitan la realización de actividades de la vida diaria y repercuten sobre la capacidad aeróbica, además de su posible influencia en la calidad de vida relacionada con la salud (CVRS). El objetivo de la presente investigación fue determinar la relación entre la capacidad aeróbica, la disnea y la calidad de vida en pacientes con EPOC que acuden a un programa de rehabilitación pulmonar (RP). Se llevó a cabo un estudio descriptivo, con diseño correlacional de corte transversal en pacientes con EPOC y con capacidad para realizar el test de caminata de los seis minutos (TC6M) y responder los cuestionarios de calidad de vida SGRQ y CRQ-SAS. Participaron 36 pacientes, de edad media 71,9±7,1, en su mayoría hombres (83,3%). Al correlacionar el TC6M y la disnea con la escala mMRC, se reportaron valores p=0,00 y r=–0,586. A su vez, se obtuvo un valor p<0,05 en el cuestionario CRQ, en los dominios emocional, fatiga y total. La distancia recorrida en el TC6M y la disnea presentan correlación con la CVRS en los dominios fatiga, ahogo y emocional del cuestionario CRQ, mientras que el cuestionario SGRQ no refleja correlaciones.

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Caso de estudio. Clínica de Occidente: franca recuperación

Este documento muestra cómo bajo un sólido planteamiento estratégico y un adecuado despliegue táctico se puede superar condiciones desfavorables de una organización que ha estado deficientemente gestionada y que se debe desenvolver en un entorno fuertemente regulado por el estado y grupos económicos poderosos. En el presente caso, se trata la historia de la Clínica de Occidente de Cali, hasta el año 2011, que pasó de ser una entidad con altos márgenes de rentabilidad enfocada en estratos medio-altos, a tener que acogerse a la Ley de Quiebra en 2004, por efecto de la implementación del nuevo Sistema de Salud de 1993. Después de un efectivo proceso de planeación estratégica alineado con el entorno, ha presentado una notoria recuperación, llevándola a un alto posicionamiento.This document describes how the use of a solid strategic plan and suitable tactic implementation can overcome unfavorable conditions in poorly managed organizations that have to operate in a strongly regulated environment under the strong influence of powerful economic groups. This case study discusses the history of Clínica Occidente in Cali until 2011. It went from being a highly profitable institution that focused on middle and high-income patients to having to file for bankruptcy under the 2004 Bankruptcy Act as a result of the implementation of a new health system in 1993. Having undergone an effective strategic planning process in alignment with the environment, the clinic has experienced a remarkable recovery that has taken it to a leading position in the industry

Caso Clínica de Occidente "de la quiebra al auge"

Las clínicas también se pueden recuperar luego de una larga y penosa enfermedad. A finales de 1999 mientras todo el planeta esperaba con algarabía el nacimiento de un nuevo milenio, la Clínica de Occidente, una de las más prestigiosas instituciones de salud en el suroccidente colombiano, se declaraba en quiebra. Miles de caleños que nacieron allí y vieron la luz por primera vez, veían como, paradójicamente, la luz de esta institución se estaba extinguiendo. La clínica, con más de 60 años de presenciar nacimientos, recuperar quebrantos y acompañar partidas de este mundo, había sufrido una larga y penosa enfermedad degenerativa ocasionada por las pérdidas financieras generadas con la entrada en vigencia de la ley 100 de seguridad social en Colombia. Como una droga paliativa, la cual se le inyecta a un paciente en sus últimos días, la institución decidió declararse en quiebra y someterse a la ley 550 de 1999.Esto implicaba endosarles el testamento a los proveedores, someterse a un acuerdo de restructuración de pasivos, y también arrepentirse y hacer expresa la voluntad de corregir las deficiencias en su capacidad de operación, de manera que pudiera recuperarse dentro del plazo establecido. Haber tocado el fondo y ver la luz al final de túnel le dio un motivo para vivir a la clínica. Como el ave fénix que sale de sus cenizas, directivas y personal sufrieron una transformación asombrosa. Todo el conjunto de personas se planteó una estrategia integral que le ha permitido en una década de recuperación y auge, no sólo cumplir las obligaciones con sus acreedores, sino que la ha posicionado como una de las clínicas más rentables de Colombia y una importante generadora de empleo en el Valle del Cauca. El recorrido por este caso busca que otras instituciones de salud y empresas privadas, que atraviesan por males similares, conozcan tácticas y estrategias que les permitan recuperarse de sus quebrantos, para que puedan seguir siendo ejemplo de recuperación para miles de pacientes