Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center

Abstract Objective: To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Methods: Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. Results: A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5 km) than by ground (median: 11.3 km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance

Estudo ecológico da sífilis gestacional e congênita na Colômbia, 2012-2019

Objective: To describe the behavior of pregnancy and congenital syphilis in Colombia between 2012 and 2018 according to national notifications records. Methodology: An ecological exploratory study was conducted based on notifications to the public health surveillance system. The incidence rate and prevalence ratio were estimated for each department. Each estimate was established per ranges for 33 departments evaluated and expressed in grayscale maps based on rates and ratios evaluated. Epidemic curves by week of notification for pregnancy and congenital syphilis are also shown. Results: Arauca, Santander, Cesar and Caldas had the highest increase in pregnancy syphilis between 2012 and 2018 while Santander, Casanare and Amazonas had an increase in congenital syphilis during the same period. Other departments had a decrease in these events. Significant differences were found in case reporting from year to year in both events in the country (p<0.001). Conclusions: In Colombia, an increase in pregnancy syphilis was found while a variability with an increasing trend was found for congenital syphilis in recent years. How to cite this article: Becerra-Arias Carolina, Alvarado-Socarras Jorge Luis, Manrique-Hernandez Edgar Fabian, Caballero-Carvajal Jhondrisson Alexis. Estudio ecológico de la sífilis gestacional y congénita en Colombia, 2012-2018. Revista Cuidarte. 2022;13(1): e2326. http://dx.doi.org/10.15649/cuidarte.2326    Objetivos: Describir el comportamiento de la sífilis gestacional y congénita en Colombia, entre el 2012 y 2018, a partir de registro de notificación Nacional. Metodología: Estudio ecológico, exploratorio a partir de Notificaciones al sistema de vigilancia de salud Pública. Se estimaron la tasa de incidencia y la razón de prevalencia para cada departamento. Se establecieron cada una las estimaciones según rangos, para los 33 departamentos evaluados y se expresaron en mapas a escala de grises según tasas y razones evaluadas. Además, se presentan curvas epidemiológicas por semanas notificación para sífilis gestacional y congénita. Resultados. Arauca, Santander, Cesar y Caldas, presentaron el mayor incremento entre 2012 y 2018 para sífilis gestacional. Para el mismo periodo, Santander, Casanare y Amazonas presentaron un aumento para sífilis Congénita, mientras que en los demás departamentos se evidenció una disminución en los eventos. Se encontraron diferencias significativas en el reporte de casos entre un año y otro, para el país, en ambos eventos (p< 0,001). Conclusiones. En Colombia se encontró un aumento de sífilis gestacional, mientras, para sífilis congénita existió variabilidad con tendencia a aumentar en los últimos años. Como citar este artículo: Becerra-Arias Carolina, Alvarado-Socarras Jorge Luis, Manrique-Hernandez Edgar Fabian, Caballero-Carvajal Jhondrisson Alexis. Estudio ecológico de la sífilis gestacional y congénita en Colombia, 2012-2018. Revista Cuidarte. 2022;13(1): e2326. http://dx.doi.org/10.15649/cuidarte.2326    Objetivos: Descrever o comportamento da sífilis gestacional e congênita na Colômbia entre 2012 e 2018, com base nos registros nacionais de notificação. Metodologia: Estudo ecológico, exploratório, baseado em notificações ao sistema de vigilância sanitária pública. A taxa de incidência e a taxa de prevalência foram estimadas para cada departamento. As estimativas foram estabelecidas de acordo com intervalos para os 33 departamentos avaliados e expressas em mapas em escala de cinza, de acordo com as taxas e rácios avaliados. Além disso, curvas epidemiológicas por semanas de notificação são apresentadas para sífilis gestacional e congênita. Resultados: Arauca, Santander, Cesar e Caldas apresentaram o maior aumento entre 2012 e 201 para a sífilis gestacional. No mesmo período, Santander, Casanare e Amazonas mostraram um aumento para a sífilis congênita, enquanto os outros departamentos mostraram uma diminuição nos eventos. Foram encontradas diferenças significativas no relato de casos de um ano para o outro, para o país, em ambos os eventos (p<0,001). Conclusões. Na Colômbia, houve um aumento da sífilis gestacional, enquanto para a sífilis congênita houve variabilidade com tendência a aumentar nos últimos anos. Como citar este artigo: Becerra-Arias Carolina, Alvarado-Socarras Jorge Luis, Manrique-Hernandez Edgar Fabian, Caballero-Carvajal Jhondrisson Alexis. Estudio ecológico de la sífilis gestacional y congénita en Colombia, 2012-2018. Revista Cuidarte. 2022;13(1): e2326. http://dx.doi.org/10.15649/cuidarte.2326     &nbsp

Staphylococcus aureus Infections Resistant to Methicillin Acquired in the Community in Children. An undeniable reality. Report of cases

Staphylococcus aureus meticilino resistente es un microorganismo aislado, principalmente a nivel hospitalario; sin embargo, esta condición ha cambiado en los últimos años, pues hoy en día se reconoce como el agente causal de infecciones adquiridas en la comunidad por niños sin factores predisponentes asociados. Esto puede variar en todo el mundo, pero hay una alerta global por el aumento del problema. En América Latina, esto ya ha sido reportado enpaíses como Argentina y Colombia. Evaluar los gérmenes circulantes a nivel regional y sus características genotípicases importante para el manejo clínico de algunos pacientes, incluso niños menores de un año, quienes también son susceptibles a este tipo de infección. En este reporte, se presentan dos casos en niños menores de un año, incluyendoun recién nacido, lo que hace de este un grupo etario susceptible. La sospecha clínica de esta bacteria de adquisiciónen la comunidad ayuda a la elección adecuada del esquema antibiótico, con mejores resultados clínicos. Por lo tanto,debe ser una prioridad realizar la vigilancia local de las infecciones por Staphylococcus aureus adquiridas en lacomunidad y determinar los protocolos de manejo, según los grupos de edad y condiciones asociadas.Staphylococcus aureus meticilino resistente es un microorganismo aislado, principalmente a nivel hospitalario; sin embargo, esta condición ha cambiado en los últimos años, pues hoy en día se reconoce como el agente causal de infecciones adquiridas en la comunidad por niños sin factores predisponentes asociados. Esto puede variar en todo el mundo, pero hay una alerta global por el aumento del problema. En América Latina, esto ya ha sido reportado enpaíses como Argentina y Colombia. Evaluar los gérmenes circulantes a nivel regional y sus características genotípicases importante para el manejo clínico de algunos pacientes, incluso niños menores de un año, quienes también son susceptibles a este tipo de infección. En este reporte, se presentan dos casos en niños menores de un año, incluyendoun recién nacido, lo que hace de este un grupo etario susceptible. La sospecha clínica de esta bacteria de adquisiciónen la comunidad ayuda a la elección adecuada del esquema antibiótico, con mejores resultados clínicos. Por lo tanto,debe ser una prioridad realizar la vigilancia local de las infecciones por Staphylococcus aureus adquiridas en lacomunidad y determinar los protocolos de manejo, según los grupos de edad y condiciones asociadas.Methicillin-resistant Staphylococcus aureus is an isolated germ mainly in hospital settings. However, this condition has changed in the last years. Today, it is recognized as a germ that causes infections acquired in the community by children, without predisposing risk factors. This may vary around the world, but there is a global alert for the increase of the problem. In Latin America, this has already been reported in some countries such as Argentina and Colombia. Evaluating the circulating germs at regional level and their genotypic characteristics is  important for the clinical management of some patients, including children under a year of age as they are also susceptible to this infection. We are presenting two cases in children under one year of age, including a neonate, which are a susceptible age group. The clinical suspicion of this acquisition bacteria in the community helps the adequate choice of the antibiotic scheme, with better clinical outcomes. Therefore, it must be a priority to carry out the local surveillance of Staphylococcus aureus infections acquired in the Community and determine the managementprotocols, according to age groups and associated conditions

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

International audienceExtracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient's recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS