Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Valoración de las habilidades comunicativas en la entrevista clínica de internos de medicina en el Hospital Goyeneche, por medio de la Escala CICAA

TesisObjetivo: Evaluar las habilidades comunicativas en la entrevista clínica de internos de medicina en el hospital Goyeneche, por medio de la escala CICAA. Diseño: Estudio descriptivo, observacional. Lugar: Consultorios de Emergencia del Hospital III Goyeneche Participantes: Estudiantes que cursen su actual internado médico. Métodos: Se grabó videos en el momento de la entrevista interno de medicina-paciente, los cuales posteriormente fueron evaluados por dos observadores ambos médicos, y analizados mediante pruebas estadísticas. Resultados: Del total de entrevistas clínicas analizadas, la mayoría de datos obtenidos fueron concordantes y fiables (k>0.75; CCI>0.75) así como la correlación entre ellas(r=0.93). El 32.3% presentaron una habilidad en comunicación aceptable. Presentan menor calificación las tareas de identificar y comprender los problemas así como la de acordar y ayudar a actuar. No hubo diferencias estadísticamente significativas entre la habilidad comunicativa y género. Conclusión: No es aceptable la habilidad comunicativa en la entrevista clínica de internos de medicina en el hospital Goyeneche