Background Most data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have been presented as case series without comparison to patients with other acute respiratory illnesses. Methods We examined emergency department patients between February 3 and March 31, 2020 with an acute respiratory illness who were tested for SARS-CoV-2. We determined COVID-19 status by PCR and metagenomic next generation sequencing (mNGS). We compared clinical presentation, diagnostics, treatment, and outcomes. Findings Among 316 patients, 33 tested positive for SARS-CoV-2; 31 without COVID-19 tested positive for another respiratory virus. Among patients with additional viral testing (27/33), no SARS-CoV-2 co-infections were identified. Compared to those who tested negative, patients with COVID-19 reported longer symptoms duration (median 7d vs. 3d, p < 0.001). Patients with COVID-19 were more often hospitalized (79% vs. 56%, p = 0.014). When hospitalized, patients with COVID-19 had longer hospitalizations (median 10.7d vs. 4.7d, p < 0.001) and more often developed ARDS (23% vs. 3%, p < 0.001). Most comorbidities, medications, symptoms, vital signs, laboratories, treatments, and outcomes did not differ by COVID-19 status. Interpretation While we found differences in clinical features of COVID-19 compared to other acute respiratory illnesses, there was significant overlap in presentation and comorbidities. Patients with COVID-19 were more likely to be admitted to the hospital, have longer hospitalizations and develop ARDS, and were unlikely to have co-existent viral infections. Funding National Center for Advancing Translational Sciences, National Heart Lung Blood Institute, National Institute of Allergy and Infectious Diseases, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative.

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BackgroundPlasmodium vivax, the most geographically distributed cause of malaria, accounts for more than 70% of cases in the Americas. In Colombia, P. vivax was responsible for 67.3% of cases in the last five years. Despite vivax malaria impact worldwide, historically it has been neglected and considered to be a benign disease. In the last decade medical literature reports have emerged countering this benign outlook. This study pretends to describe the clinical and paraclinical profile of severe vivax malaria cases hospitalized in Tumaco, Cali, Buenaventura between 2009 and 2013, to contribute to the knowledge regarding the behaviour and clinical expression of this disease.MethodsThis is a descriptive, retrospective case-series study of 16 severe malaria vivax cases, hospitalized between 2009 and 2013, in Colombian municipalities of Tumaco, Buenaventura and Cali. Severe malaria vivax cases were defined using criteria adapted from the national guidelines. Descriptive analyses of reason for consultation, signs and symptoms, diagnosis, treatment, paraclinical characteristics, complications, and time hospitalized, were conducted.ResultsSixteen cases of severe P. vivax were analysed. Fever, chills and headache were shown to be the main admission symptoms. Elevation of total bilirubin levels in 18.75%, and severe thrombocytopaenia in 25% of cases were the main complications presented during hospitalization. All cases responded to treatment, there were no deaths.ConclusionsThe following questions derived from this study could be the basis for future research: 1) Does the time to consultation have an impact on the number of days hospitalized and how cases progress during hospitalization, 2) Are the severity criteria in WHO guidelines sensitive enough to be used in clinical practice compared to national guidelines, and 3) How does malnutrition contribute to anaemia in malaria-endemic regions.

BACKGROUND: Sepsis progresses rapidly and is associated with considerable morbidity and mortality. Bedside risk stratification scores can quickly identify patients at greatest risk of poor outcomes; however, there is lack of consensus on the best scale to use. OBJECTIVE: To compare the ability of quick Sequential Organ Failure Assessment (qSOFA), the National Early Warning System (NEWS2), and the Shock Index—which does not require mental status assessment—to predict poor outcomes among patients with suspected sepsis during triage. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of adults presenting to an academic emergency department (ED) from June 2012 to December 2018 who had blood cultures and intravenous antibiotics within 24 hours. MAIN OUTCOMES AND MEASURES: Clinical data were collected from the electronic health record. Patients were considered positive at qSOFA ≥2, Shock Index >0.7, or NEWS2 ≥5 scores. We calculated test characteristics and area under the receiver operating characteristics curves (AUROCs) to predict in-hospital mortality and ED-to-intensive care unit (ICU) admission. RESULTS: We included 23,837 ED patients; 1,921(8.1%) were qSOFA-positive, 4,273 (17.9%) Shock Index-positive, and 11,832 (49.6%) NEWS2-positive. There were 1,427 (6.0%) deaths and 3,149 (13.2%) ED-to-ICU admissions in the sample. NEWS2 had the highest sensitivity for in-hospital mortality (76.0%) and ED-to-ICU admission (78.9%). qSOFA had the highest specificity for in-hospital mortality (93.4%) and ED-to-ICU admission (95.2%). Shock Index exhibited the highest AUROC for in-hospital mortality (0.648; 95 CI, 0.635-0.662) and ED-to-ICU admission (0.680; 95% CI, 0.617-0.689). Test characteristics were similar among those with sepsis. CONCLUSIONS: Institution priorities should drive score selection, balancing sensitivity and specificity. In our study, qSOFA was highly specific and NEWS2 was the most sensitive for ruling out patients at high risk. Performance of the Shock Index fell between qSOFA and NEWS2 and could be considered because it is easy to implement.

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Se analizan las condiciones laborales y de salud de los trabajadores de la Industria Maquiladora de Exportación en México. Hace uso intensivo de la fuerza de trabajo mayoritariamente femenina,constituye la segunda fuente de divisas. Ilustra una tendencia dominante en el neoliberalimo respecto a condiciones de trabajo y salud, permite apreciar el impacto de la generalizada flexibilización laboral y del creciente cambio tecnológico. El panorama de los riesgos y exigencias es complejo. En la organización laboral persisten exigencias del taylorismo, los riesgos químicos son múltiples y con probables efectos que rebasan el ámbito laboral, también existen exigencias de trabajo repetitivo y posiciones incómodas. Las repercusiones en la salud muestran elevados índices de morbilidad por demanda en los servicios de seguridad social, entre 2 y 4 veces más altos que para otros trabajadores industriales. Padecimientos asociados al estrés ocupan elevado porcentaje entre los motivos de consulta. También se muestran repercusiones en las familias, el bajo peso al nacer de los hijos es un riesgo 2.8 veces mayor para obreras de la maquila respecto de otros grupos de trabajadoras. Los accidentes laborales alcanzan cifras elevada y llegando a ser la segunda causa de consulta en algunos casos. Este análisis permite identificar algunas tendencias que en la salud laboral pueden ser importantes en los próximos años para amplios grupos de trabajadores.

BackgroundMalaria worldwide annual reported cases range between 250 and 500 million and nearly half a million deaths are reported every year. Colombia has a vast expanse of territory with environmental and social conditions conducive to malaria transmission, which is the reason why it has second place in Latin America for the number of cases of malaria.MethodsThis is a retrospective, paired, case–control study that compares patients with severe malaria and malaria patients without mention of complication. Medical records of patients with confirmed malaria diagnosis were reviewed. The objective of this study was to identify factors associated with complicated malaria in three municipalities of Colombia during the period 2009–2013.ResultsA total sample of 180 medical records was collected, 60 corresponding to cases and 120 to controls following a 1:2 ratio. From the total sample, 88.33 % (159) of subjects were originally from Tumaco, 7.78 %, most of the patients of the study (104) were diagnosed and treated in 2013. Among the laboratory findings, the platelet count was found to have statistically significant differences between cases and controls; this was also true for total bilirubin value and transaminases. The most prevalent severity finding was clinical jaundice, followed by elevated bilirubin (25 %) and elevated transaminases (44.4 %). Thrombocytopenia was found in 11/44 cases (20 %) and only five of 60 patients (8.3 %) presented severe anaemia. The multivariate analysis showed that a platelet count <100,000 and clinical jaundice not associated with organ failure, were the two variables associated with severe malaria in the patients described.ConclusionsMost of the cases studied, despite meeting criteria of severity, were shown not to be as morbid or severe as in other countries. Clinical jaundice and thrombocytopaenia are associated with severe malaria, and they can be used by general practitioners or primary care physicians to promptly identify patients who may have severe malaria.

Objetivo: Conocer la prevalencia de malaria y las características sociodemográficas de la población en el área urbana del municipio de Tumaco – Nariño. Métodos: Estudio de corte transversal descriptivo, en San Andrés de Tumaco-Nariño Colombia, entre el 1 de julio y el 30 de septiembre del 2019. Fueron incluidas 1.504 personas. Se realizaron pruebas de gota gruesa (GG) y diagnóstico rápido (PDR) para determinación de prevalencia y un cuestionario que indagó por condiciones de las viviendas y factores sociodemográficos relacionados con la presentación de malaria. Resultados: La prevalencia general de malaria fue de 0,73% (IC 95%:0,36-1,30%), lo que corresponde a 11 casos por GG y 0,53% (IC 95%: 0,22-1,0%), 8 casos por PDR; todos los casos detectados por GG, lo fueron también por PDR. La muestra de la población estuvo conformada 1.504 personas, de las cuales el 64,69% (973) fueron mujeres, población negra o afrodescendiente el 95,68% (1.439), con ingresos menores a 1 SMLV el 81,05% (1.219). El material de construcción de las viviendas fue ladrillo o bloque 55,97 % (295) y madera burda 29,60% (156). Amplia cobertura de energía eléctrica 99,24% (523), gas 96,96% (511) y acueducto 77,04% (406), inexistencia de alcantarillado y sistemas de eliminación de excretas. Discusión: Identificar los factores asociados a la dinámica de la enfermedad permite priorizar las necesidades de eliminación y proponer estrategias coherentes de prevención y gestión. Es necesario fortalecer la capacidad técnica y la oportunidad en la aplicación de pruebas de diagnóstico rápido. El área urbana de San Andrés de Tumaco continúa siendo hipoendémica para malaria y presenta factores sociodemográficos que pueden dificultar su eliminación.