Envíos recientes

D. Facultad de Medicina

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Evolución clínica y paraclínica de 9 embarazos en 4 pacientes con enfermedad de Gaucher tipo 1 en el servicio de hematología de un hospital docente asistencial

SolanoTrujillo, María Helena | 2014-07-09

Objetivo Describir la evolución clínica y paraclínica de las pacientes embarazadas con enfermedad de Gaucher tipo 1. Sujetos y métodos Pacientes que ingresaron en el servicio de hematología con diagnóstico de enfermedad de Gaucher tipo 1 y embarazo. Resultados Todas las pacientes se clasificaron de alto riesgo. Se presentaron 9 embarazos en 4 pacientes; 7 venían recibiendo terapia de reemplazo enzimático cuando quedaron embarazadas y continuaron su aplicación, una lo suspendió 8 meses antes presentando agudización a nivel hematológico. Conclusiones El embarazo no debería contraindicarse en enfermedad estable. La terapia de reemplazo no debería interrumpirse, ni suspenderse, ya que disminuye las complicaciones.

Colchicine: A potential therapeutic tool against COVID-19. Experience of 5 patients

Montealegre Gómez, Giovanni | 2020-05-16

COVID-19 is a newly emerged disease that has become a global public health challenge. Due to a lack of knowledge about the virus, a significant number of potential targets for using a particular drug have been proposed. Five cases with a clinical history of biopolymers in the gluteal region that developed iatrogenic allogenosis (IA) are presented here. The 5 cases were put under colchicine treatment for IA crisis and had non-specific symptoms (headache, cough without dyspnea, and arthralgias) with a positive SARSCoV-2 test. Their close contacts had mild to severe symptoms and three of them died. In the SARS-CoV-2 infection different inflammatory pathways are altered where colchicine reduces cytokine levels as well as the activation of macrophages, neutrophils, and the inflammasome. The possible mechanisms that colchicine may use to prevent acute respiratory distress syndrome (ARDS) in patients with COVID-19 infection are also reviewed in this article.

SARS-CoV-2 (COVID-19) en pacientes con algún grado de inmunosupresión

Cajamarca Barón, Jairo | 2020-09-11

Antecedentes: No es claro si los pacientes con algún grado de inmunosupresión tienen peores desenlaces en la infección por SARS-CoV-2, en comparación con la población sana. Objetivo: Realizar una revisión narrativa de la información disponible sobre infección por SARS-CoV2 en pacientes inmunosuprimidos, especialmente pacientes con cáncer, trasplantados, con patologías neurológicas, inmunodeficiencias primarias y secundarias. Resultados: Los pacientes con cáncer y tratamiento reciente del mismo (quimioterapia o cirugía) e infección por SARS-CoV-2 tienen mayor riesgo de peores desenlaces. En los pacientes trasplantados (renal, cardiaco y hepático), con patologías neurológicas (esclerosis múltiple [EM], neuromielitis óptica [NMODS], miastenia grave [MG]), inmunodeficiencias primarias e infección por virus de inmunodeficiencia humana (VIH) en asociación con uso de inmunosupresores, los estudios no han mostrado tendencia a peores desenlaces. Conclusión: Dada la poca evidencia con que contamos hasta el momento no es claro el comportamiento de la infección por SARS-CoV-2 en pacientes con inmunosupresión, pero los estudios actuales no han mostrado peores desenlaces en este tipo de pacientes, a excepción de los pacientes con cáncer.

Clinical and sociodemographic factors associated with lupus nephritis in Colombian patients: A cross-sectional study

Díaz Coronado, Juan C. | 2019-11-26

Introduction: Over the past decades, incidence of SLE (Systemic Lupus Erythematosus) has increased due to early case detection and improved survival of patients. SLE presents at an earlier age and has a more severe presentation in African-American, Native American, Asian, and Hispanic populations. Worldwide, lupus nephritis (LN) is observed in 29–60% of SLE patients, it has a negative impact in renal survival and patient mortality. Several cohorts have established potential risk factors associated with lupus nephritis, such as male sex, serological markers, and some extra-renal manifestations. Objectives: To describe sociodemographic, clinical, immunological, and environmental risk factors in Colombian SLE patients and to compare the population with and without nephritis, in order to establish risk factors and possible associations. Materials and methods: A total of 1175 SLE patients participated in this study. During medical care, an interview and structured survey was conducted and later registered in a database. Sociodemographic, clinical, immunological, and environmental exposure variables were analyzed. Bivariate and multivariate analyses were performed using presence of LN as an outcome. Results: Prevalence of LN was 38.7%. Variables significantly associated with LN included being male (OR 1.98), a duration of SLE > 10 years (OR 1.48), positive anti-DNA (OR 1.34), positive anti-Sm (OR 1.45), and smoking (OR 1.66). Being non-smoker was a protective factor (OR 0.52). Conclusion: This study describes potentialfactors associated with lupus nephritis in a LatinAmerican population. Smoking status could be a target for intervention as it is a modifiable risk factor. The association between being male and LN is observed in Latin-American populations such as presented here. Further research in other large-scale population studies and more efforts are needed to gain better insights to explicate these relationships.

Carga anticolinérgica en pacientes mayores de 65 años con tratamiento farmacológico ambulatorio en una población colombiana

Vallejos Narváez, Álvaro Guillermo | 2019-01-01

Introducción: los fármacos con potencial efecto anticolinérgico son prescritos frecuentemente en la población mayor de 65 años. Existen varias escalas para calcular la carga anticolinérgica: Anticholinergic Drug Scale, Anticholinergic Risk Scale y Anticholinergic Cognitive Burden. Objetivo: caracterizar la carga anticolinérgica en pacientes mayores de 65 años con polifarmacia que son formulados ambulatoriamente. Métodos: estudio de corte transversal, retrospectivo con información de prescripción registrada desde abril hasta septiembre de 2016. Se utilizó la base de datos transaccional de prescripción de una EPS nacional registrada en la plataforma tecnológica de un PBM (Pharmacy Benefit Management). Se analizaron los medicamentos con propiedades anticolinérgicas y carga anticolinérgica. Resultados: fueron 115.713 los pacientes formulados, con una edad media de 74 años. Los grupos terapéuticos más asociados con carga anticolinérgica moderada fueron, en un 6,5 %, dimenhidrinato, amantadina, biperideno y quetiapina. Un 13,1 % con carga anticolinérgica alta donde se encuentran el butil bromuro de hioscina y la amitriptilina. Discusión: el manejo de las patologías en los pacientes adultos mayores es compleja y se llega hasta el punto de requerir prescripción de múltiples medicamentos; por lo cual, se hace fundamental evaluar la necesidad del uso de estos, además de verificar su pertinencia y las posibles interacciones farmacológicas de alta significancia clínica, para evitar la presencia de eventos adversos. Por esto se han desarrollado escalas que permiten mejorar el resultado terapéutico especialmente en fármacos con carga anticolinérgica.

Metodología diagnóstica geométrica fractal y euclidiana de células de cuello uterino

Rodríguez Velásquez, Javier Oswaldo | 2013-12-13

Introducción: La interpretación patológica de las formas celulares halladas en la citología cervicovaginal es de gran importancia para la prevención del cáncer de cuello uterino. Los métodos más ampliamente utilizados para la evaluación de este examen presentan problemas de reproducibilidad y variabilidad interobservador. Objetivo: Realizar medidas fractales y euclidianas para diagnosticar matemáticamente células normales y preneoplásicas del epitelio escamoso de cuello uterino. Metodología: Se evaluaron 21 células con diagnósticos de normalidad, ASCUS y LEIBG según el sistema Bethesda. Se establecieron medidas geométricas fractales y euclidianas de tres objetos matemáticos definidos: citoplasma, núcleo y totalidad celular. Se calcularon proporciones matemáticas entre estas medidas con el fin de compararlas con los métodos de clasificación convencional. Resultados: Se encontró que las medidas del borde con la rejilla de 2 pixeles y de la superficie del núcleo celular pudieron diferenciar matemática y objetivamente las células normales y las anormales, clasificadas como ASCUS y LEIBG, cuantificando la gravedad de la lesión. Conclusiones: Se estableció una metodología diagnóstica objetiva y reproducible que permite identificar clínicamente la evolución hacia estados celulares de gravedad con base en medidas fractales y euclidianas simultáneas, aclarando el nivel de gravedad de las células ASCUS y LEIBG.

Costos directos de atención médica de accidentes de tránsito en Bogotá D.C

Gómez Restrepo, Carlos | 2014-09-01

Objetivo Determinar los costos de atención médica generados por la accidentalidad vial en Bogotá. Metodología Estudio observacional prospectivo con datos de pacientes mayores de edad atendidos en la central de urgencias de 6 instituciones hospitalarias. Resultados El promedio del costo total de atención por paciente fue de $1 112 000 el costo promedio día de paciente hospitalizado fue de $1 200 000. Pacientes con atención ambulatoria tuvieron un costo promedio de $247400. El costo promedio por accidente se calculó en $2 333 700. Los costos médicos por accidentes en el periodo de análisis en Bogotá fueron aproximadamente $2 301 028 200. Cifras en pesos colombianos de 2011. Conclusiones Los costos de la atención médica de los accidentes de tránsito constituyen una carga económica considerable.

HDR syndrome in a Colombian woman with a genital tract malformation: First case report in Latin America

Vallejo Urrego, Michael A. | 2018-09-01

Objectives Hypoparathyroidism, sensorineural deafness and renal disease (HDR) syndrome, also known as Barakat syndrome, is an autosomal dominant transmission hereditary disease with a wide range of penetrance and expressivity. Haploinsufficiency of the GATA3 two finger zinc transcription factor is believed to be its cause. This is the first time this orphan disease is reported in Latin America, so the publishing of this report is expected to raise awareness on these types of syndrome, that are usually underdiagnosed in our region, which in turn causes an increase in the years lost to disability (YLDs) rates, as well as higher costs to be assumed by public health systems.Methods A 36-year-old Colombian woman diagnosed with parathyroid gland agenesis was referred from the Endocrinology Service to the Outpatient Service. According to her medical record, in the past she had developed hypocalcaemia, left renal agenesis, hypoparathyroidism, bicornate uterus and sensorineural hearing loss. Through a gene-tic analysis a pathological mutation on the short arm of the GATA 3 gen (c.404dupC, p Ala136 GlyfsTER 167) was confirmed, which led to a HDR syndrome diagnosis. Discussion This case proves that there is a possibility that mutations described in other continents may be developed by individuals from our region. Regardless of eth-nicity, Barakat syndrome should be considered as a possible diagnosis in patients pre-senting the typical triad that has been described for this condition, since there could be underdiagnosis of this disease in Latin-America due to the lack of knowledge on this condition in said region, and that genetic counseling in these patients is of great impor-tance for the implications of the syndrome in future generations.

II Consenso Colombiano para el Manejo de la Osteoporosis Posmenopáusica

Medina Orjuela, Adriana | 2018-02-01

La Asociación Colombiana de Osteoporosis y Metabolismo Mineral se reunió a principios de 2017 para actualizar el Consenso Colombiano de Osteoporosis, elaborado por primera vez en 2005, un paso que se consideró necesario en vista del subdiagnóstico de esta enfermedad, el impacto esperado del envejecimiento poblacional y los cambios en el tratamiento farmacológico que ha habido desde entonces. Se seleccionó un equipo técnico con especialistas de múltiples áreas y amplia trayectoria, repartidos en 4 grupos de trabajo: definición y epidemiología, diagnóstico, tratamiento farmacológico y medidas no farmacológicas. Luego de una revisión de la literatura científica, en reuniones de trabajo se generaron las definiciones y recomendaciones que se resumen en este documento.

Evaluation of concordance among three cardiac output measurement techniques in adult patients during cardiovascular surgery postoperative care

Muñoz, Luis | 2017-09-30

Introduction: The standard method for cardiac output measuring is thermodilution although it is an invasive technique. Transesophageal Echocardiography (TEE) offers a dynamic and functional alternative to thermodilution. Objective: Analyze concordance between two TEE methods and thermodilution for cardiac output assessment. Methods: Observational concordance study in cardiovascular surgery patients that required pulmonary artery catheter. TEE cardiac output measurement at both mitral annulus (MA) and left ventricle outflow tract (LVOT) were performed. Results were compared with thermodilution. Correlation was evaluated by Lin’s concordance correlation coefficient and Bland---Altman analysis. Statistical analysis was undertaken in STATA 13.0.Results: Twenty-five patients were enrolled. Fifty two percent of patients were male, median age and ejection fraction was 63 years and 35% respectively. Median thermodilution, LVOT and MA -measured cardiac output was 3.25 L/min, 3.46 L/min and 8.4 L/min respectively. Different values between thermodilution and MA measurements were found (Lin concordance = 0.071; Confidence Interval 95% = −0.009 to 0.151; Spearman’s correlation = 0.22) as values between thermodilution and LVOT (Lin concordance = 0.232; Confidence Interval 95% = −0.12 a 0.537; Spearman’s correlation 0.28). Bland---Altman analysis showed greater difference between MA measurements and thermodilution (DM = −0.408; Bland---Altman Limits = −0.809 to −0.007), than the other echocardiographic findings (DM = 0.007; Bland---Altman Limits = −0.441 to 0.428). Conclusion: Results from cardiac output measurement by doppler and 2D-TEE on both MA and LVOT do not correlate with those obtained by thermodilution.

Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud

Vásquez Hoyos, Patricia | 2019-12-09

Introducción: El fallo respiratorio agudo es la principal causa de hospitalización en pediatría. Las cánulas nasales de alto flujo (CNAF) ofrecen una nueva alternativa, pero sigue existiendo debate en torno a la evidencia e indicaciones. No se ha descrito su comportamiento en gran altitud. Objetivo: Describir el uso de CNAF en pacientes pediátricos que ingresan con insuficiencia respiratoria y explorar los factores asociados al fracaso de la terapia. Metodología: Estudio de cohortes prospectivo. Pacientes entre un mes y 18 anos ˜ manejados con CNAF. Se describieron datos demográficos y se evaluó la respuesta al inicio, 1.a , 6.a y 24.a horas. Se determinó el número de fracasos, así como estancia, complicaciones y mortalidad. Se compararon los pacientes con fracaso al tratamiento. Resultados: Ingresaron 539 pacientes. Fueron más frecuentes los lactantes (70,9%) de sexo masculino (58,4%) con afecciones respiratorias como asma y bronquiolitis (61,2%). Se presentaron 53 fracasos (9,8%), 21 en las primeras 24 horas. La mediana de estancia fue de 4 días (RIQ 4), hubo 5 éxitus (0,9%) y 13 eventos adversos ---epistaxis--- (2,2%). Se observó mejoría de signos vitales y gravedad en el tiempo con diferencias en el grupo que fracasó, pero sin interacciones. El modelo logístico final estimó una relación independiente del fracaso, entre el hospital (OR 2,78; IC95% 1,48-5,21) y la frecuencia respiratoria inicial (OR 1,56; IC95% 1,21-2,01).Conclusión: La CNAF es un sistema con buena respuesta clínica, pocas complicaciones y una baja tasa de fracasos. Las diferencias entre las instituciones sugieren una relación subjetiva de la decisión del fracaso.

La diferencia venoarterial de dióxido de carbono en la reanimación de pacientes con sepsis grave y shock séptico: una revisión sistemática

Diaztagle Fernández, Juan José | 2017-05-16

Introducción: La forma de evaluar la perfusión tisular durante la reanimación de pacientes con sepsis grave y shock séptico es tema de estudio y debate en la actualidad. La saturación venosa de oxígeno y el lactato han sido los criterios más utilizados; sin embargo, presentan limitaciones reconocidas. La diferencia venoarterial de dióxido de carbono (delta de pCO2) es una variable que puede indicar el estado de perfusión tisular, por lo que su evaluación puede ser útil en estos pacientes. Métodos: Revisión sistemática cualitativa de la literatura que incluyó estudios que evaluaron el delta de pCO2 en pacientes adultos con sepsis grave o shock séptico, publicados entre enero de 1966 y noviembre de 2016 en las bases de datos Medline-PubMed, Embase-Elsevier, Cochrane Library y LILACS. No tuvo restricción de idiomas. Se siguió la declaración PRISMA y se evaluó la calidad metodológica. Resultados: Doce estudios fueron incluidos, todos observacionales, 10 prospectivos, 9 publicados a partir del 2010. Cinco documentaron una mayor mortalidad entre pacientes con delta de pCO2 alto, en 3 incluso cuando conseguían metas de saturación venosa de oxígeno. En 4 estudios, un delta de pCO2 alto se relacionó con una menor saturación venosa de oxígeno y niveles mayores de lactato, y otros 3 documentaron un menor porcentaje de disminución de lactato. Conclusión: El delta de pCO2 ha sido evaluado en el manejo de los pacientes con sepsis grave y shock séptico con mayor frecuencia en los últimos anos. ˜ Los estudios demuestran su relación con la mortalidad y otros desenlaces clínicos, de tal forma que puede ser una herramienta útil en el manejo de estos pacientes.

Curso de instrucción Astrágalo vertical congénito: protocolo terapéutico

Ochoa del Portillo, Gabriel | 2012-03

El astrágalo vertical congénito es una deformidad infrecuente del pie que se presenta al nacimiento y que se caracteriza por un pie plano rígido asociado a una luxación irreductible del escafoides sobre el astrágalo, que puede tener grados variables de rigidez. Esta deformidad, de no ser tratada, produce dolor e incapacidad funcional para la marcha. El diagnóstico es clínico y se confirma mediante estudios radiográficos, principalmente dinámicos, que demuestran la irreductibilidad de la luxación de la articulación astrágalo-escafoidea. Por la gran diversidad de factores etiológicos capaces de producir la deformidad, por la rigidez y la complejidad de los cambios morfo-mecánicos, se han diseñado a lo largo de la historia gran cantidad de tratamientos, la mayoría de ellos con resultados reportados como aceptables en series de casos de revisiones retrospectivas con escasa cantidad de pacientes. Se propone un protocolo de tratamiento racional, enfocado a grupos de edad en los cuales la deformidad, asociada a deformación ósea adaptativa, se estructura progresivamente y que puede proporcionar resultados más favorables a largo plazo, cuando están indicadas las cirugías extensas.

Use of Pulse Pressure Variation as Predictor of Fluid Responsiveness in Patients Ventilated With Low Tidal Volume: A Systematic Review and Meta-Analysis

Alvarado Sánchez, Jorge Iván | 2020-01-24

Introduction: Pulse pressure variation (PPV) has been shown to be useful to predict fluid responsiveness in patients ventilated at tidal volume (Vt) >8 mL kg−1. Nevertheless, most conditions in critical care force to use lower Vt. Thus, we sought to evaluate the operative performance of PPV when a Vt ⩽8 mL kg−1 is used during mechanical ventilation support. Methods: We searched PubMed and Embase databases for articles evaluating the operative performance of PPV as a predictor of fluid responsiveness in critical care and perioperative adult patients ventilated with tidal volume ⩽8 mL kg−1 without respiratory effort and arrhythmias, between January 1990 and January 2019. We included cohort and cross-sectional studies. Two authors performed an Independently selection using predefined terms of search. The fitted data of sensitivity, specificity, and area under the curve (AUC) were assessed by bivariate and hierarchical analyses. Results: We retrieved 19 trials with a total of 777 patients and a total of 935 fluid challenges. The fitted sensitivity of PPV to predict fluid responsiveness during mechanical ventilation at Vt ⩽8 mL kg−1 was 0.65 (95% confidence interval [CI]: 0.57-0.73), the specificity was 0.79 (95% CI: 0.73-0.84), and the AUC was 0.75. The diagnostic odds ratio was 5.5 (95% CI: 3.08-10.01, P < .001) by the random-effects model. Conclusions: Pulse pressure variation shows a fair operative performance as a predictor of fluid responsiveness in critical care and perioperative patients ventilated with a tidal volume ⩽8 mL kg−1 without respiratory effort and arrhythmias.

Pediatric diabetic ketoacidosis in a patient with down syndrome. Case report

Camacho, Jhon | 2019-01-01

Introduction:. Patients with Down syndrome (DS) have an increased risk of developing autoimmune diseases. This is a rare case of a pediatric patient with DS with an initial clinical profile of diabetic ketoacidosis. Case presentation:. 6-year-old male patient with symptoms suggestive of diabetes mellitus type 1 (DM1) of 15 days of evolution (polyuria, polydipsia, polyphagia and loss of 2 kilos of weight), who was admitted to the emergency department of the Hospital de San José, in Bogotá, Colombia, with uncontrollable vomiting and dehydration. The tests performed confirmed moderate ketoacidosis: glycometry: 592 mg/dL, pH: 7.19, HCO3: 10 mmol/L, PCO2: 45, PO2: 95 and lactic acid: 1.4 mmol/L. Management with isotonic fluids and intravenous insulin therapy was initiated and the patient was transferred to the pediatric intensive care unit, where ketoacidosis was controlled in approximately 10 hours. Subcutaneous insulin schedule was initiated without complications. Discussion:. This case highlights the importance of monitoring possible autoimmune complications in patients with DS, since the risk of developing them is 4.2 times higher than in the general population. Conclusion:. This case calls on to contemplate autoimmune complications in patients with DS during clinical practice. Although they are not part of the most frequent reasons for consultation, they cannot be underestimated and should be suspected and treated in a timely manner.

Cardiovascular Magnetic Resonance Imaging Evidence of Edema in Chronic Chagasic Cardiomyopathy

Díaz, Andrés | 2019-09-05

The persistence of inflammatory processes in the myocardium in varying degrees of chronic Chagas heart disease has been poorly investigated. We hypothesized that edema could occur in patients with chronic chagasic cardiomyopathy and corresponds to the persistence of inflammatory processes in the myocardium. Eighty-two Chagas disease (CD) seropositive patients (64.6% females; age = 58.9 ± 9.9) without ischemic heart disease or conditions that cause myocardial fibrosis and dilation were considered. Late gadolinium enhancement (LGE) and T2-weighted magnetic resonance imaging of edema were obtained and represented using a 17-segment model. Patients were divided into three clinical groups according to the left ventricular (LV) ejection fraction (EF) as G1 (EF > 60%; ), G2 (35% > EF < 60%; ), and G3 (EF < 35%; ). Comparisons were performed by the Fisher or ANOVA tests. Bonferroni post hoc, Spearman correlation, and multiple correspondence analyses were also performed. Edema was observed in 8 (9.8%) patients; 2 (5.4%) of G1, 4 (12.1%) of G2, and 2 (16.7%) of G3. It was observed at the basal inferolateral segment in 7 (87.5%) cases. LGE was observed in 48 (58.5%) patients; 16 (43.2%) of G1, 21 (63.6%) of G2, and 11 (91.7%) of G3 (). It was observed in the basal inferior/inferolateral/anterolateral segments in 35 (72.9%) patients and in the apical anterior/inferior/lateral and apex segments in 21 (43.7%), with midwall (85.4%; ), subendocardial (56.3%; ), subepicardial (54.2%; ), transmural (31.2%; ), and RV (1.2%; ) distribution. Subendocardial lesions were observed only in patients with LVEF < 35%. There was no involvement of the mid-inferolateral/anterolateral segments with an LVEF > 35% (). Deteriorations of the LV and RV systolic functions were positively correlated (; ) without evidence of LGE in the RV. Edema can be found in patients with chagasic cardiomyopathy in the chronic stage. In later stages of cardiac dilation with low LVEF, the LGE pattern involves subendocardium and mid locations. Deteriorations of RV and LV are positively correlated without evidence of fibrosis in the RV.

Latin American Collaborative Research on Aplastic Anemia (LARAA): creating a regional registry

Abello, Virginia | 2019-12-06

Aplastic anemia (AA) is a rare but serious disease that affects hematopoietic stem cells and is characterized by pancytopenia and a hypocellular bone marrow. It can be a hereditary or acquired condition. Acquired AA has an incidence of 2 per million per year in Europe, but the incidence is two to three times higher in Asia. In Latin America, there is little epidemiologic data on this disease. The most important treatments for AA are bone marrow transplantation and immunosuppressive treatment with antithymocyte globulin and cyclosporine. But access to these treatments is restricted in some areas of Latin America. At the American Society of Hematology (ASH) Annual Meeting in 2016, representatives of the Hematology Societies of Latin America, with the support of the ASH International Program, met to discuss possible collaborative efforts. Everyone agreed that lack of reliable information is one of the main barriers to designing significant clinical trials for the region; therefore, starting a registry of hematologic diseases for the region has become a main goal of the group. In April 2017, at the ASH Highlights meeting in Latin America, AA was selected as the first disease that would be used to begin the collaborative action. National hematology societies of Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Paraguay, Peru, Uruguay, and Venezuela have made a commitment to help develop the Latin American Registry for Aplastic Anemia (LARAA).

Quality Assessment of Clinical Practice Guidelines for the Prescription of Antidepressant Drugs During Pregnancy

Santos, Fabiano | 2012-07

Antidepressant use during the gestational period remains a controversial issue. The objective of this study was to appraise the quality of the available clinical practice guidelines (CPGs) that includes recommendations for antidepressant use during pregnancy. We systematically searched for documents published between January 2000 and September 2010 in MEDLINE / TRIP database and on clearinghouses and main scientific societies websites. Four appraisers evaluated each guideline using the Appraisal of Guidelines for Research and Evaluation tool (AGREE II). Intra-class correlation coefficients (ICC) with 95% confidence intervals (CI) were calculated as an overall indicator of agreement. Twelve CPGs were included from a total of 539 references. Only two guidelines were specifically addressed to pregnant women. The overall agreement among reviewers was high (ICC: 0.94, 95% CI: 0.86-0.98). The mean scores and standard deviation (SD) for each of the AGREE II domains were: scope and purpose: 84.4% (12); stakeholder involvement: 67.4% (29.8); rigor of development: 68.6% (19.8); clarity and presentation: 83.4% (17.4); applicability: 44% (37.3); and editorial independence: 62.1% (30.4). After standardizing the scores of the 12 guidelines, 5 were considered as being “recommended”, 5 as “recommended with modifications, and 2 as “not recommended”. Among the five recommended guidelines, two were specifically conceived to the gestational period. CPGs containing recommendations for antidepressant use during pregnancy were of moderate to high quality. Future guidelines should take into account the observed drawbacks in some domains, and specifically focus a more in depth approach of depression during pregnancy

Alzheimer’s Disease Dementia Guidelines for Diagnostic Testing: A Systematic Review

Arévalo Rodríguez, Ingrid | 2013-01-02

Alzheimer’s disease dementia (AD dementia) is one of the most common neurodegenerative diseases worldwide, with a growing incidence during the last decades. Clinical diagnosis of cognitive impairment and presence of AD biomarkers have become important issues for early and adequate treatment. We performed a systematic literature search and quality appraisal of AD dementia guidelines, published between 2005 and 2011, which contained diagnostic recommendations on AD dementia. We also analyzed diagnostic recommendations related to the use of brief cognitive tests, neuropsychological evaluation, and AD biomarkers. Of the 537 retrieved references, 15 met the selection criteria. We found that Appraisal of Guidelines Research and Evaluation (AGREE)-II domains such as applicability and editorial independence had the lowest scores. The wide variability on assessment of quality of evidence and strength of recommendations were the main concerns identified regarding diagnostic testing. Although the appropriate methodology for clinical practice guideline development is well known, the quality of diagnostic AD dementia guidelines can be significantly improved.

Pediatric Critical Care and COVID-19

González-Dambrauskas, Sebastián | 2020-09

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, disproportionally affects adults (children <5% in most reports).1 Adult critical illness is characterized by acute hypoxemia, multiorgan failure, and high mortality.2,3 Reported risk factors for severe illness include age, cardiorespiratory comorbidities, obesity, and laboratory findings (lymphopenia and elevated D-dimer).2,4 Pediatric reports describe low infection rates and infrequent PICU admission.5,6 The largest PICU report consists of 48 North American children.7 It describes treatments and outcomes but not with adequate granularity to understand critical pediatric COVID-19. The Critical Coronavirus and Kids Epidemiology Study was designed to specifically investigate severe cases and provide detailed data. It involves >60 centers in nearly 20 countries from the Americas and Europe. In this report, we provide preliminary insights into our first 17 patients. Methods The Critical Coronavirus and Kids Epidemiology is a cohort study of children <19 years old with severe or critical COVID-19. The study period runs from April through December 2020. For this report, we included patients enrolled through April 23. We defined critical COVID-19 as a positive severe acute respiratory syndrome coronavirus 2 test result and requiring ICU therapies (high-flow nasal cannula [HFNC], noninvasive ventilation [NIV], invasive mechanical ventilation [IMV], vasoactive support, continuous renal replacement therapy). Severe COVID-19 included those receiving mask or nasal oxygen exceeding the pediatric acute respiratory distress syndrome (ARDS) “at risk” threshold.8 Deidentified data were collected by using a modification of the International Severe Acute Respiratory and Emerging Infection Consortium form (https://isaric.tghn.org/COVID-19-CRF/). Local ethics approval was obtained with a waiver of need for consent. Results We enrolled 17 children from 10 PICUs in Chile, Colombia, Italy, Spain, and the United States. Detailed data are in the Supplemental Information. Most patients were male (65%), young (median 4 years; range 0.08–18 years), and without known COVID-19 exposure (14 of 17). Comorbidities (Table 1, Supplemental Table 3) were common (71%) but variable. Symptoms were heterogenous, with fever and cough being most frequent (Table 1, Supplemental Table 3). Most with gastrointestinal (GI) symptoms (4 of 6) were also diagnosed with myocarditis (Supplemental Table 4). All these were from Europe and without previous cardiovascular disease.