El síndrome de norte-sur, una complicación de la asistencia circulatoria con ECMO Venoarterial. Reporte de caso

We present the case of a 34-year-old male patient with a history of Marfan syndrome who was admitted to the emergency room for acute aortic regurgitation secondary to aneurysmal dilation of the ascending thoracic aorta. In the postoperative period, post-cardiotomy cardiogenic shock was documented, so circulatory support was initiated with peripheral Veno-Arterial ECMO, which developed hypoxemia due to bacterial pneumonia and data compatible with North-South syndrome. We present a review, non-conventional cannulation strategies and a diagnostic alternative for this entity.Presentamos el caso de un paciente masculino de 34 años con diagnóstico previo de síndrome de Marfan que ingresó por Insuficiencia aórtica aguda secundario a dilatación aneurismática de la aorta torácica ascendente. En el posoperatorio se documentó choque cardiogénico poscardiotomía por lo que se inició soporte circulatorio con ECMO venoarterial periférico, el cual desarrolló hipoxemia por neumonía bacteriana y datos compatibles con síndrome norte-sur. Presentamos una revisión, estrategias de canulación no convencional y una alternativa diagnóstica para esta entidad

Asociación de la nutrición enteral temprana con desenlaces clínicos en pacientes sometidos a cirugía cardiaca en una unidad de cuidados intensivos cardiovasculares

Introduction: Early enteral nutrition (EEN) has been associated with improved clinical outcomes in subpopulations of patients in the intensive care unit (ICU). However, little evidence is available in critically ill patients undergoing cardiac surgery. Objective: To analyze the association between EEN with important clinical outcomes. Methods: Retrospective cohort study in post-surgical adult patients admitted to the ICU between august 2021 and october 2022, who required invasive mechanical ventilation (IMV) for more than 48 hours. The association between EEN use and ICU mortality, days under IMV, and days of ICU stay were evaluated through logistic and linear regression tests. Results: 74 patients were considered in the final analysis. The median days of ICU stay was lower in the EEN group compared to the delayed enteral nutrition group [8 (IQR 6 - 14) vs. 18 (7 - 31), p = 0.005, respectively], the same was observed with days under IMV [4 (3 - 6) vs. 11 (5 - 24), p = 0.000, respectively]. EEN was associated with decreased in hospital mortality (OR 0.21; 95%CI 0.07, 0.67; p = 0.009) and ICU mortality (OR 0.21; 95%CI 0.5, 0.84; p = 0. 027), as well as with days in ICU (β -8.03; 95%CI -13.44, -2.62; p = 0.004) and days under IMV (β -11.86; 95%CI -17.97, -5.74; p = 0.000) in the adjusted model. Conclusions: In critically ill patients undergoing cardiac surgery, EEN may be related to a decrease in hospital and ICU mortality, as well as length of ICU stay and days under IMV.Introducción: La nutrición enteral temprana (EEN) se ha asociado con mejores desenlaces clínicos en subpoblaciones de pacientes que se encuentran en la unidad de cuidados intensivos (UCI). Sin embargo, existe poca evidencia disponible en pacientes críticos sometidos a cirugía cardiaca. Objetivo: analizar la asociación entre la EEN con desenlaces clínicos importantes. Métodos: Estudio de cohorte retrospectivo en pacientes adultos postquirúrgicos ingresados a la UCI entre agosto de 2021 y octubre de 2022 que requirieron ventilación mecánica invasiva (VMI) por más de 48 horas. Se evaluó la asociación entre el uso de EEN y mortalidad hospitalaria y en la UCI, días bajo VMI, y días de estancia en UCI a través de pruebas de regresión logística y lineal. Resultados: 74 pacientes fueron considerados en el análisis. La mediana de días de estancia en la UCI fue menor en el grupo con EEN comparado con el grupo nutrición enteral tardía [8 (IQR 6 - 14) vs. 18 (7 - 31), p = 0.005, respectivamente], esto mismo fue observado con los días bajo VMI [4 (3 - 6) vs. 11 (5 - 24), p = 0.000, respectivamente]. La EEN se asoció con una disminución de mortalidad hospitalaria (OR 0.21; IC95% 0.07, 0.67; p = 0.009) y en la UCI (OR 0.21; IC95% 0.5, 0.84; p = 0.027), así como con los días de estancia en la UCI (β -8.03; IC95% -13.44, -2.62; p = 0.004) y días bajo VMI (β -11.86; IC95% -17.97, -5.74; p = 0.000) en el modelo ajustado. Conclusiones: En pacientes críticos sometidos a cirugía cardiaca el inicio de EEN puede estar relacionado con una disminución en la mortalidad hospitalaria y en la UCI, así como con los días de estancia en la UCI y bajo VMI

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Características clínicas, modalidades de tratamiento y mortalidad en la ruptura del septum interventricular posinfarto

Objetivo: Conocer las características, estrategia de tratamiento y mortalidad en pacientes con infarto agudo al miocardio y ruptura del septum interventricular posinfarto. Métodos: Se incluyeron 40 pacientes atendidos en un periodo de ocho años por infarto agudo al miocardio complicado con ruptura del septum interventricular posinfarto. Se utilizó ecocardiograma para confirmar la ruptura del septum interventricular posinfarto. Se evaluaron las características clínicas, el tipo de tratamiento y la mortalidad hospitalaria. Las variables se compararon con prueba U de Mann-Withney o prueba exacta de Fisher. Resultados: Edad 64 años (56 a 73), 67% hombres, 53% diabetes, 43% hipertensión, 40% tabaquismo. Los tratamientos fueron: conservador 45%, quirúrgico 38% o dispositivo Amplatzer 17%. La mortalidad general fue de 65%, con manejo conservador 54%, con cirugía 35% y con Amplatzer 12% (p = 0.02), y estuvo asociada a menor tiempo entre infarto agudo al miocardio y ruptura del septum interventricular posinfarto (p <0.001) y menor tiempo entre ruptura del septum interventricular posinfarto y tratamiento de cierre (p <0.001). Todos los pacientes con Killip Kimbal III o IV murieron. Conclusiones: Hasta el momento no existe una estrategia de manejo en la ruptura del septum interventricular posinfarto que demuestre ventajas sobre las demás. El único marcador de buen pronóstico podría ser el mayor tiempo entre la ruptura y el tratamiento de cierre. Es probable que la indicación de manejo de las guías internacionales no aplique para todos los pacientes y estos deban estratificarse de acuerdo a su estado hemodinámico

Asociación de la nutrición enteral temprana con desenlaces clínicos en pacientes sometidos a cirugía cardiaca en una unidad de cuidados intensivos cardiovasculares

Introducción: La nutrición enteral temprana (EEN) se ha asociado con mejores desenlaces clínicos en subpoblaciones de pacientes que se encuentran en la unidad de cuidados intensivos (UCI). Sin embargo, existe poca evidencia disponible en pacientes críticos sometidos a cirugía cardiaca. Objetivo: analizar la asociación entre la EEN con desenlaces clínicos importantes. Métodos: Estudio de cohorte retrospectivo en pacientes adultos postquirúrgicos ingresados a la UCI entre agosto de 2021 y octubre de 2022 que requirieron ventilación mecánica invasiva (VMI) por más de 48 horas. Se evaluó la asociación entre el uso de EEN y mortalidad hospitalaria y en la UCI, días bajo VMI, y días de estancia en UCI a través de pruebas de regresión logística y lineal. Resultados: 74 pacientes fueron considerados en el análisis. La mediana de días de estancia en la UCI fue menor en el grupo con EEN comparado con el grupo nutrición enteral tardía [8 (IQR 6 - 14) vs. 18 (7 - 31), p = 0.005, respectivamente], esto mismo fue observado con los días bajo VMI [4 (3 - 6) vs. 11 (5 - 24), p = 0.000, respectivamente]. La EEN se asoció con una disminución de mortalidad hospitalaria (OR 0.21; IC95% 0.07, 0.67; p = 0.009) y en la UCI (OR 0.21; IC95% 0.5, 0.84; p = 0.027), así como con los días de estancia en la UCI (β -8.03; IC95% -13.44, -2.62; p = 0.004) y días bajo VMI (β -11.86; IC95% -17.97, -5.74; p = 0.000) en el modelo ajustado. Conclusiones: En pacientes críticos sometidos a cirugía cardiaca el inicio de EEN puede estar relacionado con una disminución en la mortalidad hospitalaria y en la UCI, así como con los días de estancia en la UCI y bajo VMI

Association of the Transmembrane Serine Protease-2 (TMPRSS2) Polymorphisms with COVID-19

SARS-CoV-2 uses the ACE2 receptor and the cellular protease TMPRSS2 for entry into target cells. The present study aimed to establish if the TMPRSS2 polymorphisms are associated with COVID-19 disease. The study included 609 patients with COVID-19 confirmed by RT-PCR test and 291 individuals negative for the SARS-CoV-2 infection confirmed by RT-PCR test and without antibodies anti-SARS-CoV-2. Four TMPRSS2 polymorphisms (rs12329760, rs2298659, rs456298, and rs462574) were determined using the 5&prime;exonuclease TaqMan assays. Under different inheritance models, the rs2298659 (pcodominant2 = 0.018, precessive = 0.006, padditive = 0.019), rs456298 (pcodominant1 = 0.014, pcodominant2 = 0.004; pdominant = 0.009, precessive = 0.004, padditive = 0.0009), and rs462574 (pcodominant1 = 0.017, pcodominant2 = 0.004, pdominant = 0.041, precessive = 0.002, padditive = 0.003) polymorphisms were associated with high risk of developing COVID-19. Two risks (ATGC and GAAC) and two protectives (GAGC and GAGT) haplotypes were detected. High levels of lactic acid dehydrogenase (LDH) were observed in patients with the rs462574AA and rs456298TT genotypes (p = 0.005 and p = 0.020, respectively), whereas, high heart rate was present in patients with the rs462574AA genotype (p = 0.028). Our data suggest that the rs2298659, rs456298, and rs462574 polymorphisms independently and as haplotypes are associated with the risk of COVID-19. The rs456298 and rs462574 genotypes are related to high levels of LDH and heart rate