Scielo RSS <![CDATA[Revista médica del Hospital General de México]]> vol. 84 num. 2 lang. es <![CDATA[SciELO Logo]]> <![CDATA[Vaccines against severe acute respiratory syndrome coronavirus-2 (March 23<sup>th</sup> 2021]]> <![CDATA[Posterior basal segments atelectasis in descending necrotizing mediastinitis]]> Abstract Background: We have observed that patients with descending necrotizing mediastinitis show bilateral lower lobes atelectasis before pleural effusion that finally forms empyema. Successful treatment of mediastinitis emphasizes optimal early drainage of neck, mediastinum, and antibiotic therapy. Methods: Exploratory study to determine the presence of segmental atelectasis as incipient sign of mediastinitis. We studied patients from August 2018 to July 2019 with tomographies. Results: We evaluated 25 patients operated due to Mediastinitis at our hospital, from August 2018 to July 2019. Ten (40%) were females and 15 (60%) were male patients. Twenty-one (84%) patients showed atelectasis and 4 (16%) did not have atelectasis. Of the patients that showed atelectasis, 17 (81%) were bilateral, 2 (9.5%) were right sided, and 2 (9.5%) were left sided. We also analyzed the occurrence of pleural effusion in this group. Fifteen (60%) patients had pleural effusion and 10 (40%) did not. Of the total patients with pleural effusion 11 (73.3%) were bilateral, 3 (20%) of the right side, and 1 (6.6%) of the left side. Conclusions: Atelectasis is a sign that we can find in most patients that will develop empyema and we assume that it is associated with lymph nodes inflammation, but it is necessary to develop other protocols to confirm that hilar lymph congestion is the cause of atelectasis. As atelectasis of lower lobes is a sign of imminent sepsis, we always decide to do mediastinal drainage when we find them associated with neck abscess. We are proposing a modification of the endo classification to decide surgery. <![CDATA[Demographic and clinical characteristics in asymptomatic health workers with positive SARS-CoV-2 test, Hospital General de México “Dr. Eduardo Liceaga”]]> Objective: The objective of the study was to describe the demographic and clinical characteristics found in personnel screened during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Materials and methods: Nasal and oropharyngeal swab samples were collected in the period between May 11 and May 26, 2020, from 496 people. They were followed up by means of a questionnaire at 0, 7, and 14 days. Results: 449 people answered the surveys (73 excluded); age range: 21-63 years, mean of 39.4 years. About 77% had contact with patients with coronavirus infection, (32% had an exposure time of &lt; 8 h a week, 24% 8-16 h a week and 20% more than 16 h a week). The most frequent comorbidity in the population was obesity (13.8%), followed by asthma (8%) and DM2 (1%). The most common symptom was headache (34%), followed by nasal obstruction (25%) and odynophagia in third place (22%); 16% presented alterations in the perception of odors. Among the surveyed personnel, 17 (4.5%) tested positive for SARS-COV2 by means of reverse transcription polymerase chain reaction. Conclusions: In line with this pandemic, a screening protocol was started for asymptomatic health-care personnel for the recognition of infections caused by this virus to establish barriers that will prevent the spread and provide the basis for the standardization of this practice and the protection of health-care personnel. <![CDATA[Biomarkers associated with coronavirus disease-19 disease progression in a Mexican hospital]]> Abstract Introduction: The Coronavirus disease (COVID-19) pandemic is a worldwide challenge. There are few useful tools to predict patient outcomes. Identification of biomarkers able to predict progression of the disease could improve the treatment of these patients. Objective: The objective of the study was to identify biomarkers of disease progression among patients with severe COVID-19 pneumonia. Materials and methods: A retrospective cohort study was conducted among severe COVID-19 pneumonia patients hospitalized in the American British Cowdray Medical Center in Mexico City. Disease progression was defined as use of vasoactive amines, need of non-invasive or invasive mechanical ventilation or death. Studied biomarkers included neutrophil/lymphocyte index, lymphocyte/platelet Ratio, C reactive protein, procalcitonin, D Dimer, lactic dehydrogenase (LDH), ferritin, 25-OH-Vitamin D, and interleukin 6. Results: We report 46 patients with severe COVID-19 pneumonia. Mean age was 51 years, the majority of whom 30 (65%) male. Median hospitalization was 9 days. 23 (50%) of patients presented disease progression. Ferritin and LDH were strongly associated with disease progression among our cohort. In addition, age was associated with worst prognosis with a relative risk 4.5 (1.2-16.9, p = 0.003). Conclusions: Age, ferritin, and LDH were associated with disease progression among patients with severe COVID-19 pneumonia. <![CDATA[Asymptomatic vascular lesion due to a firearm projectile of the right arm of 30 days of evolution. Case report]]> Abstract A 27-year-old male patient presenting a gunshot wound in the right arm with slight paraesthesia in the tips of his fingers. Patient was referred to the orthopedic unit to undergo bone fixation due to a fracture of the right radius, with absent distal pulses. He also presented vascular compromise. An arteriography was requested that showed vascular injury of the humeral artery. A reverse saphenous vein graft was placed. The patient had good evolution with normal pulses. <![CDATA[Right idiopathic popliteal aneurysm in a 5-year-old boy: Case report]]> Abstract We describe the case of a 5-year-old boy with an idiopathic popliteal artery aneurysm on the right leg, who presented the first clinical manifestations from the age of 3 months, with an increase in the circumference of the right lower limb, visible superficial venous system and purplish coloration, without compromised mobility. A final imaging diagnosis was made when patient was 2 years old, through computed tomography angiography, with subsequent surgical repair at 5 years by popliteal-popliteal bypass (supra-infra patellar), bypass bridge with reversed greater saphenous vein, anastomosis with continuous stitches, proximal, and distal ligation of the aneurysm. Patient evolves satisfactorily in the post-operative period. <![CDATA[Chronic venous disease: Literature review]]> Abstract The venous system is responsible for bringing blood from the lower limbs to the heart. To achieve this, various mechanisms are activated that work against gravitational force. A very important mechanism is the function of the venous valves. A family history of venous disease is most commonly associated with valve dysfunction, which can lead to venous hypertension, amongst several other risk factors, thus activating a cascade of events characterized by venous dilation and leukocyte migration. Chronic complications can be very expensive in relation to quality of life and the health system. At present, venous disease studies include several diagnostic methods that, together with a wide range of therapeutic tools, have achieved excellent results in the quality of life of patients. <![CDATA[Integration of palliative care to the emergency department. Management algorithm approach]]> Abstract Regarding medical emergencies, physicians exclusively deal with seriously ill patients suffering from advanced, progressive, and chronic diseases, where the diagnostic and therapeutic approach becomes simultaneous. Sometimes with a very wide range of possibilities that lead to a greater complexity when identifying if the patient is in the last phase of life. Thus, there is a risk of falling into therapeutic obstinacy or disinterest leaving aside the main objective of ensuring the comfort of these patients. In response to this need, our work team carried out an algorithm that aims to integrate palliative care to the emergency service, by identifying end-of-life patients, in addition to implementing management proposals for each stage thereof.