Introducción:Valores elevados del Índice de Shock (IS) se han asociado con un incremento en la mortalidad y con la necesidad de requerimiento de transfusiones masivas en pacientes traumatizados, pero su habilidad para identificar pacientes que requieran Cirugía de Control de Daños (CCD) es desconocida. El objetivo de este estudio fue identifica un punto de corte del IS para predecir necesidad de CCD en pacientes con trauma penetrante. Materials y métodos:Estudio retrospectivo por un periodo de 10 años que incluyo todos los pacientes adultos que ingresaron por trauma penetrante de torso a un Centro de Trauma de referencia. El IS fue calculado al ingreso y los pacientes se dividieron en los que necesitaron CCD y los que no (No-CCD). Para determinar la exactitud del IS identificando pacientes que requirieron CCD se calculo el Área Bajo la Curva ROC (AUROC) del 95%. Conclusión: El IS puede ser en cierto grado indicativo de la necesidad de CCD en los pacientes con trauma penetrante de torso, sin embargo un punto específico de corte para predecir CCD no fue estadísticamente encontrado. Source of support: Nil Conflict of interest: None ABSTRACT Introduction:The objective of our study was to identify a possible shock index (SI) cutoff number that could reliable predicts the need for damage control surgery (DCS) in penetrating trauma patients. Materials and methods:A retrospective 10-year study (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) which included all adult patients that suffered penetrating torso trauma at a level I trauma center. The SI was calculated upon admission and patients were divided into two groups: those that required DCS and those that did not (No-DCS). A 95% confidence interval for the area under a receiver operating characteristic curve (AUROC) was used to determine the accuracy of SI in detecting patients that would require DCS.Results: A total of 747 patients were included, 92.3% were male and 80% suffered gunshot wounds. The DCS group had a total of 331 (44%) Conclusions:We have shown that SI can be indicative to some degree of the need for DCS in patients suffering penetrating torso trauma but a specific cutoff point that can precisely predict this need is statically unobtainable.
Introduction: Malaria infection, anaemia and intestinal parasitism, are important public health problems in Colombia. Available data suggests that these are not separate conditions, but interrelated. On the other hand, retinol supplementation successfully decreases mortality in children. In malaria endemic areas, this supplement reduces severe malaria in children, due to immune modulation by retinol. For example, retinoic acid induced a bias towards a TH2 immune response, an event that is associated with protection against severe anaemia. This review aimed at describing some relationships, reported in global biomedical literature, between retinol and malaria; retinol and anaemia; retinol, malaria and intestinal parasites; anaemia and malaria; and to how the TH1/TH2 cytokine pattern in individuals with malaria changes according to retinol supplementation. Methods: The following biomedical literature databases were consulted: Medline, Lilacs, Spingerlik, Md. Consultant, Web of Science, Ovid, Scient Direct, Ebsco and Cochrane. Information documenting prevalence of malnutrition, subclinical retinol deficiency, anaemia and malaria in Colombian children, as well as papers on the anti-infectious role of retinol were also. Results: A relationship between malaria and intestinal parasitic infections was reported. Some studies indicate that helminth infection predispose children to suffer malaria. On the other hand, these intestinal parasites have also been associated with anaemia and low retinol plasma concentrations, which in turn are associated with malaria. No co-relation regarding a simultaneous link between all these conditions, and the TH1/TH2 balance was observed. Conclusions: The study of associations between malaria, anaemia, intestinal parasite infections and low retinol level, with the TH1/TH2 cytokine response as centerpiece is essential to prevent or provide early treatment.
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