Validez entre la tonometría de schiotz vs la tonometría de goldman respecto a la medición de la presión intraocular en pacientes diabéticos tipo II, de edades comprendidas entre 40 a 70 años, del Hospital Enrique Garcés en el periodo de junio a octubre del año 2015 para su aplicación en atención primaria de salud

Validez entre la tonometría de Schiotz vs la tonometría de Goldman respecto a la medición de la presión intraocular en pacientes diabéticos tipo II, de edades comprendidas entre 40 a 70 años, del Hospital Enrique Garcés en el periodo de junio a octubre del año 2015 para su aplicación en atención primaria de salud. Autores: Miguel E. Medina Escudero y Oscar G. Venegas Baca. Lugar y fecha: Clínica de diabetes del hospital Enrique Garcés Quito-Ecuador 2015-2016. Objetivo: Validar los resultados de PIO obtenidos mediante el método de Schiotz vs Goldman, en pacientes mayores de 40 años con diagnóstico previo de diabetes tipo II de la clínica de diabetes del hospital Enrique Garcés para su aplicación en atención primaria de salud. Método: Se realizó un estudio prospectivo transversal, planteado en un periodo de tiempo determinado, de características analíticas, descriptivas. Previo a información del estudio y firma voluntaria del consentimiento informado por parte del paciente, se realizó la medición de presión intraocular (PIO) en cada ojo con el tonómetro de Schiotz y posteriormente con el tonómetro de Goldman, usando como película lagrimal en los dos métodos fluroceina más lidocaina; todas las mediciones se realizaron en horario matutino. Para el procesamiento de la información se utilizó el programa SPSS, versión 22, mediante el cual se aplicó determinación de asociaciones, frecuencias, prueba de datos no paramédicos entre las variables de nuestro estudio. Resultados: La muestra final fue de 129 pacientes, del análisis de datos se obtuvo que el 97,7% de pacientes corresponden a la etnia mestiza, mientras que el 2,3% se identifican como afrodescendientes. Además, de toda la muestra, sólo un paciente, que representa el 0,8% de la muestra presentó antecedente familiar de glaucoma, siendo el mismo de origen materno. En cuanto a la diabetes, se dividió a la nuestra población en dos grupos, tomando como punto de corte, el valor de hemoglobina glicosilada de 7 mg/dl, encontrando que en la muestra el 25,58% de pacientes presentaron diabetes mellitus no controlada, mientras que el 74,42% era controlada. Además, se dividió en niveles de hemoglobina glicosilada a cada grupo, hallando que dentro del grupo de diabetes controlada el 41,86% de pacientes poseían niveles entre 6,5-7mg/dl, el 31,78% se encontraban en niveles entre 5,7-6,4mg/dl y el 0,78% tenían niveles menores o iguales a 5,6mg/dl. En cuanto al grupo de diabetes no controlada, el 21,71% pacientes se encontraban en niveles de hemoglobina glicosilada comprendidos entre 7,1-8mg/dl, mientras que en el grupo de 9,1-10 mg/dl se ubicó el 3,10% de la muestra y por último en el grupo de 10-12 mg/dl se encontró el 0,78% de pacientes. Con el tiempo de diagnóstico, se realizó una agrupación para dividir la edad a la que se realizó el mismo y otro grupo que muestra los años que cada paciente lleva con dicho diagnóstico. En el primer grupo, el 26,36% de pacientes se encontraban en la edad entre 60-70 años, el 36,45% entre los 50-59 años, el 24,03% entre 40-49 años y en 14,18% menos de 40 años. En cuanto al grupo de años que lleva con la enfermedad, el 69,72% de pacientes lleva 5 años o más con el diagnóstico de diabetes tipo II, el 23,26% lleva entre 3-4 años y el 6,8% lleva 2 años o menos con dicha patología

Evaluación de procedimientos y dispositivos utilizados por el personal de anestesiología para la intubación endotraqueal en pacientes sometidos a anestesia general durante el tiempo de pandemia por COVID-19, Quito, 2020-2021

La presente investigación pretende evaluar las técnicas y medidas tomadas por el personal de anestesiología de la ciudad de Quito para la intubación de pacientes sometidos a anestesia general durante el período de pandemia por COVID-19. Métodos: Se realizó un estudio descriptivo transversal en 129 participantes entre anestesiólogos y posgradistas de anestesiología, quienes efectuaron procedimientos de intubación endotraqueal en pacientes que requieren anestesia general. La información se recolectó mediante una encuesta digital sobre técnicas y normas de intubación; en base a las guías de la Sociedad Ecuatoriana de Anestesia y mediante el uso del programa SPSS se realizó un análisis descriptivo univariado y bivariado según el tipo de personal, infección por COVID, y medidas para la intubación. Resultados: El 30,2% de participantes presentó infección por COVID-19, de éstos el 60% reportó su contagio intrahospitalario. En cuanto a las barreras usadas para la protección, el 55% utilizó una cabina de acrílico al inicio de la pandemia, mientras que en los últimos tres meses el 80.6% no utilizó ningúna barrera. En relación con el dispositivo usado para la intubación, al inicio el 44.2% utilizó el videolaringoscopio, este valor no se modificó en el tiempo, dado que el 58.9% de los médicos reportaron que dicho dispositivo era el único con el que contaban. El tipo de secuencia de inducción usada al inicio fue la secuencia rápida en 81.4%, misma que disminuyó a 44.2% en los últimos 3 meses. La mayor probabilidad de infección por COVID fue en los médicos que atendieron pacientes con este diagnóstico y los que trabajaron en hospitales de segundo nivel, con los siguientes valores de OR respectivamente 2,41(IC95% 1,04-5,57), 3,68(IC95% 1,17-11,52; mientras que aquellos que recibieron pacientes con prueba para COVID-19 realizada al ingreso tuvieron menor probabilidad de infección OR 0,20(IC95% 0,07-0,06). Conclusiones: Al evaluar las técnicas aplicadas, la mayoría de los médicos cumplió con los lineamientos sugeridos por las guías. Menos de la mitad de los médicos reportó contar siempre con herramientas para el manejo de vía aérea y equipos como videolaringoscopio

Dolor agudo. Fisiopatología-Diagnóstico-Tratamiento

Los principios de la terapia del dolor han cambiado notablemente desde la aparición de la IASP (Asociación Internacional para el Estudio del Dolor) en 1973. En esa época, se usaban mucho la pentazocina, la meperidina, etc. Sus propiedades influían en cada aspecto de la terapia del dolor y producían complicaciones como insuficiencia renal, delirium, depresión respiratoria, excitación en las salas de recuperación, náuseas, vómitos, abstinencia y tolerancia, razón por la que han sido descontinuados. Estamos pasando la fase de uso de opioides y debemos examinar otros métodos. La esperanza de que pueda surgir algún compuesto que no se base en los conceptos de los últimos doscientos años anima aún a la investigación de los más diversos agentes como las fenciclidinas, neurolépticos, esteroides y bloqueadores de receptores de NMDA. En muchos laboratorios, están en marcha análisis neurofarmacológicos y bioquímicos, por ejemplo, de remimazolam o parches de buprenorfina de duración prolongada (Norspan 10 mg), y los algólogos esperan ávidamente los resultados para la incorporación de los mismos en la terapia del dolor. A pesar de lo anterior, el principiante debe conocer perfectamente las bases de la algología, pues los aspectos del tratamiento del dolor agudo, algunos síndromes y el tratamiento agudo del cáncer son el motivo de esta edición que conserva muchas características que se seguirán perfeccionando en futuras ediciones

Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries

Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. Methods: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). Results: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. Conclusions: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.Revisión por pare

Polymorphisms at phase I-metabolizing enzyme and hormone receptor loci influence the response to anti-TNF therapy in rheumatoid arthritis patients

© Springer Nature Limited 2018The aim of this case-control study was to evaluate whether 47 single-nucleotide polymorphisms (SNPs) in steroid hormone-related genes are associated with the risk of RA and anti-TNF drug response. We conducted a case-control study in 3 European populations including 2936 RA patients and 2197 healthy controls. Of those, a total of 1985 RA patients were treated with anti-TNF blockers. The association of potentially interesting markers in the discovery population was validated through meta-analysis with data from DREAM and DANBIO registries. Although none of the selected variants had a relevant role in modulating RA risk, the meta-analysis of the linear regression data with those from the DREAM and DANBIO registries showed a significant correlation of the CYP3A4rs11773597 and CYP2C9rs1799853 variants with changes in DAS28 after the administration of anti-TNF drugs (P = 0.00074 and P = 0.006, respectively). An overall haplotype analysis also showed that the ESR2GGG haplotype significantly associated with a reduced chance of having poor response to anti-TNF drugs (P = 0.0009). Finally, a ROC curve analysis confirmed that a model built with eight steroid hormone-related variants significantly improved the ability to predict drug response compared with the reference model including demographic and clinical variables (AUC = 0.633 vs. AUC = 0.556; PLR_test = 1.52 × 10-6). These data together with those reporting that the CYP3A4 and ESR2 SNPs correlate with the expression of TRIM4 and ESR2 mRNAs in PBMCs (ranging from P = 1.98 × 10-6 to P = 2.0 × 10-35), and that the CYP2C9rs1799853 SNP modulates the efficiency of multiple drugs, suggest that steroid hormone-related genes may have a role in determining the response to anti-TNF drugs.KEY POINTS• Polymorphisms within the CYP3A4 and CYP2C9 loci correlate with changes in DAS28 after treatment with anti-TNF drugs.• A haplotype including eQTL SNPs within the ESR2 gene associates with better response to anti-TNF drugs.• A genetic model built with eight steroid hormone-related variants significantly improved the ability to predict drug response.This work was supported by grants from FIBAO foundation (Granada, Spain), Novo Nordisk Fonden (NNF15OC0016932), Knud og Edith Eriksens Mindefond and Gigtforeningen (A2037, A3570).info:eu-repo/semantics/publishedVersio

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care