Abstract Background: In Mexico, 29% of mortality resulting from SARS-CoV-2 was associated with one or more comorbidities. Diabetes mellitus was one of the most frequently increasing in-hospital mortality. Objective: This study was aimed at determining the impact of nosocomial infections in diabetic patients diagnosed with COVID-19. Materials and methods: An analysis of 930 patients with SARS-CoV-2 was performed, grouping data from April 2020 to December 2021. Survival, hospital stay, causative agents, antimicrobial resistance, and comorbidities were the variables of interest. Results: About 30% of patients had diabetes mellitus, which presented a greater number of concomitant comorbidities such as arterial hypertension in 50%, and chronic kidney disease in 13%. The survival function was higher in patients without diabetes mellitus. Conclusions: The association between nosocomial infections and diabetes mellitus increased hospital length of stay and mortality, which is why multidisciplinary teams are important to carry out prevention programs and establish hospital sanitation measures.

Abstract This work aims to investigate the ultimate capacity of reinforced concrete elements in terms of cracking and stiffness loss. Nonlinear finite element analysis (NLFEA) was performed in the ATENA software and compared with a proposed numerical simulation of nonlinear static analysis (NLSA), where material cracking is evaluated based on the loss of tangent stiffness of the elements. The analysis was applied to a low-rise reinforced concrete frame with constant axial loads in the columns, and monotonic lateral load applied at the top beam level. Both methodologies showed good agreement regarding the capacity curve and crack patterns, and the numerical simulation NLSA allowed the identification of the sequence of elements' stiffness loss. The results indicated a substantial similarity between the numerical simulation NLFEA and NLSA and the experimental test, indicating a high potential in predicting the nonlinear behavior of reinforced concrete.

Resumo Este trabalho tem como objetivo investigar a capacidade última de elementos em concreto armado em termos de fissuração e perda de rigidez. Uma análise não linear via método dos elementos finitos (MEF) foi realizada no programa ATENA e comparada com uma simulação numérica de análise estática não linear (AENL), onde a fissuração do material é avaliada com base na perda de rigidez tangente dos elementos. As análises foram aplicadas a um pórtico em concreto armado com cargas axiais constantes nos pilares, e carga lateral monotônica aplicada na viga superior. Ambas as metodologias mostraram boa concordância em relação à curva de capacidade e panorama de fissuração, e a simulação numérica AENL permitiu identificar a sequência de perda de rigidez dos elementos. Os resultados indicaram grande semelhança entre a simulação numérica FEM e AENL e ensaio experimental, indicando um alto potencial para prever o comportamento não linear do concreto armado.

Summary: Introduction: congenital gastroschisis is an increasingly demanded pathology, therefore a care protocol was implemented at the Pereira Rossell Pediatric Hospital (CHPR), and it has been carried out by a multidisciplinary team. In this paper, we aim at assessing the morbidity and mortality impact of survival and morbidity of this application. Materials and Methods: comparative before and after study of a historical cohort (GH, n=29) versus a post-protocol application cohort (GP, n=18), in patients with a gestational age ≥36 weeks and birth weight ≥2500 grams assisted in CHPR between 2016-2021. Results: no perinatal differences were observed between both groups or in the incidence of complicated GQ. In the GP, a higher incidence of early abdominal closure was decreased (GH 3.4% vs GP 67%, p<0.01), less need to perform a surgical silo (GH 100% vs GP 33%, p<0.01 ), shorter mechanical ventilation administration time (GH 2 days vs GP 0.5 days, p=0.03), total use of opioids (GH 3.5 days vs GP 7 days, p<0.01) , of administration of parenteral nutrition (GH 24.5 days vs GP 20 days, p=0.03), and earlier start of enteral feeding (GH 11 days vs GP 7 days, p=0.03). No differences in survival after hospital discharge (93% vs 89%, p=0.63). Conclusions: the application of a standardized protocol was linked to a significant reduction in the time of abdominal closure, mechanical ventilation, parenteral nutrition, and opioids, with earlier initiation of enteral nutrition.

Resumen: Introducción: la gastrosquisis congénita (GC) es una patología con creciente demanda asistencial. Atentos a esto, en el Centro Hospitalario Pereira Rossell (CHPR) se implementó un protocolo de cuidados llevado adelante por un equipo multidisciplinario. En este trabajo nos proponemos evaluar el impacto en la sobrevida y morbilidad a partir de su aplicación. Material y método: estudio comparativo tipo antes y después de pacientes portadores de GC (n = 47), 29 de una cohorte histórica (GH) y 18 de una cohorte posaplicación de protocolo (GP). Con edad gestacional ≥ 36 semanas y peso al nacer ≥ 2500 g, asistidos en el CHPR entre los años 2016 y 2021. Resultados: no se observaron diferencias perinatales entre ambos grupos, ni en la incidencia de GQ complicadas. En el GP se observó mayor incidencia de cierre abdominal precoz (p < 0,01), menor necesidad de realización de silo quirúrgico (p < 0,01), menor tiempo de administración de ventilación mecánica (p = 0,03), de uso total de opioides (p < 0,01), de administración de nutrición parenteral (p = 0,03), e inicio más temprano de la alimentación enteral (p = 0,03). Sin diferencias en la sobrevida al egreso hospitalario. Conclusiones: la aplicación de un protocolo estandarizado se asoció a una reducción significativa en el tiempo de cierre abdominal, de ventilación mecánica, nutrición parenteral y de opioides, con inicio más precoz de la nutrición enteral.

Resumo: Introdução: a gastrosquise congênita (GC) é uma patologia com demanda crescente de atendimento e, porém, foi implementado um protocolo de atendimento por equipe multidisciplinar no Centro Hospitalar Pediátrico Pereira Rossell (CHPR). Neste trabalho propomos avaliar o impacto na mortalidade e morbidade depois de sua aplicação. Material e Métodos: estudo comparativo antes e depois de pacientes com CG (n=47), sendo 29 de uma coorte histórica (GH) e 18 de uma coorte pós-aplicação de protocolo (GP). Idade gestacional ≥ 36 semanas e peso ao nascer ≥ 2.500 gramas atendidos no CHPR entre os anos de 2016-2021. Resultados: não foram observadas diferenças perinatais entre os dois grupos ou na incidência de QG complicada. No GP observou-se maior incidência de fechamento abdominal precoce (p<0,01), menor necessidade de silos cirúrgicos (p<0,01), menor tempo de administração de ventilação mecânica (p=0,03) e uso total de opioides. (p<0,01), administração de nutrição parenteral (p=0,03) e início mais precoce da alimentação enteral (p=0,03). Não houve diferenças na sobrevivência até a alta hospitalar. Conclusões: a aplicação de protocolo padronizado foi associada à redução significativa do tempo de fechamento abdominal, ventilação mecânica, nutrição parenteral e opioides, com início mais precoce da nutrição enteral.

Summary: Perinatal hypoxic ischemia and its most feared complication, hypoxic ischemic encephalopathy, remain one of the main reasons for admission to neonatal care. Controlled hypothermia is currently the recommended treatment for patients with moderate to severe encephalopathy, given its neuroprotective nature against hypoxic-ischemic brain injury. Although the inclusion criteria for this therapy have been well established, there are still difficulties both in the early identification of those who may benefit, and in making decisions regarding situations of controversy between the available evidence and that being developing in ongoing studies. This paper aims at providing tools so that clinicians can address different scenarios that arise during their daily practice.

Resumen: La hipoxia isquemia perinatal y su complicación más temida, la encefalopatía hipóxica isquémica, continúa siendo uno de los principales motivos de ingreso a las unidades de cuidados neonatales. En la actualidad la hipotermia controlada es el tratamiento recomendado para los pacientes con encefalopatía moderada a severa, dado su carácter de neuroprotección ante la injuria cerebral hipóxico isquémica. Si bien los criterios de inclusión en esta terapia han sido bien establecidos, aún hay dificultades tanto en la identificación precoz de aquellos que pueden verse beneficiados, como en la toma de decisiones ante situaciones de controversia entre la evidencia disponible y la que se está gestando en estudios en curso. Este artículo pretende aportar herramientas al clínico para abordar diferentes escenarios que surgen de la práctica diaria.

Resumo: A hipóxia isquêmica perinatal e sua complicação mais temida, a encefalopatia hipóxico-isquêmica, continuam sendo um dos principais motivos de internação em unidades de cuidados neonatais. A hipotermia controlada é atualmente o tratamento recomendado para pacientes com encefalopatia moderada a grave, dada a sua natureza neuroprotetora contra lesão cerebral hipóxico-isquêmica. Embora os critérios de inclusão dessa terapia estejam bem estabelecidos, ainda há dificuldades tanto na identificação precoce daqueles que podem se beneficiar, quanto na tomada de decisões em situações de controvérsia entre as evidências disponíveis e aquelas que estão se desenvolvendo em estudos em andamento. Este paper tem como objetivo fornecer ferramentas aos clínicos para abordar diferentes cenários que surgem da prática diária.

Abstract: Neonatal calf diarrhea (NCD) is a severe infectious disease, distributed worldwide. In Uruguay, the calf mortality rate in dairy farms associated with infectious diseases is high. Colostrum intake constitutes the primary source of antibodies of neonates and correlates with good tracers of health and survival during the suckling stage. Vaccination against NCD improves the colostrum’s immunoglobulin composition in pregnant cows. Its correct consumption ensures the transmission of antibodies to the calf and should prevent or reduce the occurrence and outcome of diseases. Several vaccines against NCD are on the market, containing E. coli bacterin, purified E. coli fimbriae together with toxoids, and viral antigens. E. coli CS31A+ bacterin have been included in some vaccines against NCD. The prevalence of clpG is one of the highest among E. coli virulence genes in calves feces in Uruguay. ClpG is the structural protein of CS31A adhesin. This work aimed to determine the level of anti-ClpG antibodies in the colostrum of Holstein-Friesian cows without vaccination and vaccinated against NCD in Uruguay. The colostrum composition was analyzed to determine the functional state of the mammary gland. Non-significant differences were determined in the colostrum-protein or -lactose composition. The differences in terms of fat were assumed on the average for colostrum. A recombinant ClpG protein was purified using a prokaryotic expression system from E. coli. ELISA analyses showed anti-ClpG antibodies in both groups of bovines, reflecting the natural exposure of cows to E. coli CS31A+ strains. Mixed model analysis showed no variance homogeneity between groups but significant differences in medians of the IgG values between groups of cows. A tendency to increase the amount of IgG against ClpG in the colostrum of vaccinated cows was observed, which can result in a better outcome for the calves if the passive transfer of IgG effectively occurs.

Resumen: La diarrea neonatal de terneros (DNT) es una enfermedad infecciosa grave a nivel mundial. En Uruguay, la tasa de mortalidad de terneros asociada a enfermedades infecciosas es alta. El calostro constituye la principal fuente de anticuerpos y se correlaciona con buenas trazas de salud y supervivencia durante la lactancia. La vacunación contra la DNT mejora la composición de inmunoglobulinas del calostro en vacas preñadas y su correcto consumo asegura la transmisión de anticuerpos al neonato. Las vacunas contra la DNT frecuentemente contienen bacterina o fimbrias purificadas de E. coli, como bacterina de E. coli CS31A+, así como antígenos virales. La prevalencia de clpG es una de las más altas entre los genes de virulencia de E. coli en heces de terneros en Uruguay. ClpG es la proteína estructural de la adhesina CS31A. El objetivo del trabajo fue determinar el nivel de anticuerpos anti-ClpG en calostro de vacas holstein-friesian sin vacunar y vacunadas contra la DNT en Uruguay. Se analizó el estado funcional de la glándula mamaria. No se encontraron diferencias significativas en la composición de proteína o lactosa. Las diferencias en términos de la grasa se asumieron dentro del promedio para el calostro. Para los análisis de anticuerpos se purificó una proteína ClpG recombinante usando un sistema de expresión en E. coli. Los análisis de ELISA mostraron anticuerpos anti-ClpG en ambos grupos, lo que refleja la exposición natural de las vacas a cepas E. coli CS31A+. Con el modelo mixto utilizado no se detectó homogeneidad de varianza, pero sí diferencias significativas en las medianas de los valores de IgG entre vacas vacunadas y no vacunadas. En vacas vacunadas se observó una tendencia de aumento de IgG anti-ClpG en el calostro, lo que podría resultar en un mejor resultado para los terneros si la transferencia pasiva ocurre efectivamente.

Resumo: A diarréia neonatal em bezerros (DNB) é uma doença infecciosa grave em todo o mundo. No Uruguai, a taxa de mortalidade de bezerros associada a doenças infecciosas é alta. O colostro representa a principal fonte de anticorpos e está correlacionado com bons indicadores de saúde e sobrevivência durante a lactação. A vacinação contra a DNB melhora a composição de imunoglobulinas do colostro em vacas prenhes e o seu correto consumo garante a transmissão de anticorpos ao neonato. As vacinas contra DNB geralmente contêm bacterina ou fímbrias purificadas de E. coli, como a bacterina de E. coli CS31A+, bem como antígenos virais. A prevalência de clpG é uma das mais altas entre os genes de virulência de E. coli em fezes de bezerros no Uruguai. ClpG é a proteína estrutural da adesina CS31A. O objetivo do trabalho foi determinar o nível de anticorpos anti-ClpG no colostro de vacas Holandesas não vacinadas e vacinadas contra DNB no Uruguai. O estado funcional da glândula mamária foi analisado. Não foram encontradas diferenças significativas na composição de proteína ou lactose. As diferenças em termos de gordura foram consideradas dentro da média do colostro. Para as análises de anticorpos, uma proteína ClpG recombinante foi purificada usando um sistema de expressão de E. coli. As análises de ELISA mostraram anticorpos anti-ClpG em ambos os grupos, refletindo a exposição natural das vacas às cepas de E. coli CS31A+. Com o modelo misto utilizado, não foi detectada homogeneidade de variância, mas foram encontradas diferenças significativas nas medianas dos valores de IgG entre vacas vacinadas e não vacinadas. Em vacas vacinadas, foi observada uma tendência de aumento de IgG anti-ClpG no colostro, o que poderia resultar em um melhor resultado para os bezerros se a transferência passiva ocorresse de forma efetiva.

Abstract: This paper presents a prototype of an automobile driver assistance system based on YOLOv3. The system detects car types, traffic signs, and traffic lights in real-time and warns the driver accordingly. In the learning phase of the YOLO algorithm, the standard weights are learned first, followed by transfer learning to the objects of interest. The retraining phase uses 2,800 images obtained from the Internet of three countries of the real-life, and the testing phase uses real-time videos of Mexico City roads. In the validation phase, the proposed system achieves 95%, 37%, and 40% performance on the compiled dataset for the detection of road elements. The results obtained are comparable and in some cases better than those reported in previous works. Using a Raspberry Pi 4, the prototype was tested in real-life, generating visual and audible warnings for the driver, with an object recognition rate of 0.4 fps. A mean average precision (mAP) of 53% was reached by the proposed system. The experiments showed that the prototype achieved a poor recognition rate and required high computational processing for object recognition. However, YOLO is a model that can have good performance on low-resource hardware.

Resumen Introducción: El trasplante renal es el tratamiento de elección de la enfermedad renal en etapa terminal (ERT). Desde marzo de 2020, la actividad de trasplantes en México se ha visto afectada debido a la pandemia de COVID-19. Objetivo: Determinar el impacto en la mortalidad de pacientes en lista de espera (LE) para trasplante renal de donante cadavérico en un hospital de referencia en Yucatán, por suspensión de actividades debido a la pandemia. Material y métodos: Pacientes > 18 años en LE para trasplante renal en este hospital. En caso de muerte de un paciente, se investigó la causa, especialmente si estaba asociada a COVID-19. Un valor de p de dos colas ≤ 0.05 se consideró significativo en todos los análisis. Resultados: La razón de probabilidad de muerte por COVID-19 en un paciente con ERT en la LE en 2020 fue OR = 5.04 (IC 95%: 1.65-7.14, p = 0.023). La razón de probabilidad de morir con ERT en la LE con retraso en las consultas de seguimiento fue de OR = 6.59 (IC 95%: 2.7-16.28, p = 0.008). Conclusión: La probabilidad de muerte de un paciente con ERT en la LE con retraso en las consultas de seguimiento y retención del trasplante es estadísticamente más alta que la probabilidad de muerte por COVID-19.

Abstract Introduction: Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Since March 2020, transplant activity in Mexico has been affected due to the COVID-19 pandemic. Objective: The aim of the study was to determine the impact on mortality of patients on the waiting list (WL) for cadaveric donor kidney transplantation in a referral hospital in Yucatán, due to suspension of activities due to the pandemic. Material and methods: Patients over 18 years of age on the waiting list for kidney transplantation at this hospital. In the event of a patient's death, the cause was investigated, especially if it was associated with COVID-19. A two-tailed p ≤ 0.05 was considered significant in all analyzes. Results: The odds ratio (OR) of death from COVID-19 in a patient with ESRD in the WL in 2020 was OR = 5.04 (95% CI: 1.65-7.14, p = 0.023). The OR of dying with ESRD in the WL with a delay in the follow-up visits was OR = 6.59 (95% CI: 2.7-16.28, p = 0.008). Conclusion: The probability of death of a patient with ESRD with delayed follow-up visits and transplant retention is statistically higher than the probability of death from COVID-19.

Resumen Se presenta el primer registro de la traza fósil Elipsoideichnus meyeri Roselli, 1987, de afloramientos de la cantera Prefectura Naval Argentina, Parque Nacional El Palmar, Colón (provincia de Entre Ríos), Argentina. E. meyeri consiste en un nido de abeja fósil helicoidal, hasta la fecha solo registrado en la Formación Asencio (Cuenca Norte) del suroeste de Uruguay. El nuevo espécimen fue encontrado en rocas tradicionalmente asignadas a la Formación Puerto Yeruá (Cuenca Chaco Paraná), consideradas del Cretácico Superior sobre la base del contenido paleontológico de estratos correlativos en el área, conformado por restos de dinosaurios y plantas. Sin embargo, el marco estratigráfico más confiable para la localidad de estudio debería mantener los nombres litoestratigráficos de la Cuenca Norte de Uruguay, siendo el principal argumento para la presencia de una discordancia regional entre las formaciones Guichón y Mercedes, lo que imposibilita la asignación de este nuevo registro a la Formación Puerto Yeruá. Las facies observadas y este nuevo registro en sí permitieron la asignación preliminar de los estratos portadores de E. meyeri de la Prefectura Naval Argentina a la Formación Asencio, reforzado por el registro que aquí se presenta ya que no existe evidencia tafonómica que apoye un transporte significativo horizontal o vertical del mismo. Sobre la asignación cronoestratigráfica de este registro, no existen elementos concluyentes para ubicarlo dentro del Cretácico Superior o Eoceno, siendo un hecho aún en análisis. Este registro amplía la distribución geográfica de este icnotaxón, permitiendo el desarrollo de nuevas investigaciones en el área, reabriendo interrogantes relacionados con la paleobiología y la cronoestratigrafía de abejas antiguas en esta zona del sur de América del Sur.

Abstract We present the first record of the trace fossil Elipsoideichnus meyeri Roselli, 1987, from out-crops of the Prefectura Naval Argentina quarry, Parque Nacional El Palmar, Colón (Entre Ríos province), Argentina. E. meyeri consists of a singular helicoidal fossil bee nest, to date only recorded from the Asencio Formation (Norte Basin) of southwestern Uruguay. The new specimen came from rocks tra-ditionally assigned to the Puerto Yeruá Formation (Chaco Paraná Basin), considered Upper Cretaceous in age based on paleontological content of correlative strata in the area, composed of dinosaur and plant remains. However, the most reliable stratigraphic framework for the studied locality should keep the lithostratigraphic names of the Norte Basin of Uruguay, being the main argument for the presence of a regional unconformity between Guichón and Mercedes formations, which precludes the assignment of this new record to the Puerto Yeruá Formation. Observed facies and this new record itself allowed the preliminary assignation of Prefectura Naval Argentina E. meyeri-hosting strata to the Asencio Formation, which is reinforced by the record presented here itself due to there are no taphonomic evidence supporting significant transport horizontally or vertically. About the chronostratigraphic assignment of this record, there are no concluding elements to locate it within the Upper Cretaceous or Eocene, being a matter of fact and still in flux. This record expands the geographical distribution of this ichnotaxon, allowing the development of further research in this area and, re-opening questions related to the palaeobiology and chronostratigraphy of ancient bees in this area of southern South America.

RESUMEN INTRODUCCIÓN En Argentina, la obesidad en adultos es una problemática con una prevalencia media de 25,4%. En la relación entre COVID-19 y obesidad, se observa mayor prevalencia de sobrepeso/obesidad y enfermedad severa entre los pacientes con COVID-19. Por ello, el objetivo del estudio fue conocer las características clínicas y epidemiológicas en pacientes con diagnóstico de obesidad sobrevivientes a la infección por SARS-CoV-2. MÉTODOS Se realizó un estudio observacional descriptivo y analítico de corte transversal. Se aplicó una encuesta autoadministrada. RESULTADOS La mediana de edad fue 41 años, y hubo un 69,9% de mujeres. Los síntomas de presentación más prevalentes fueron astenia (86,7%), anosmia (64,5%) y tos (64%). Con respecto a los síntomas persistentes luego de las 12 semanas del diagnóstico, los más prevalentes fueron astenia (52,9%), trastornos de sueño (32,4%) y falta de concentración/memoria (31,7%). Hubo mayor riesgo en mujeres (OR: 2,86; IC95%: 2,23-3,67) con obesidad (OR: 1,58; IC95%: 1,16-2,16). La enfermedad grave en obesos fue casi el triple comparado con no obesos (15,7% vs. 5,4%; p<0,001). DISCUSIÓN Los pacientes obesos mostraron síntomas de presentación que orientan a un estado inflamatorio sistémico, con disnea y tos más frecuentes, y tienen mayor prevalencia de enfermedad grave y neumonía, así como mayor riesgo de desarrollar síntomas persistentes, sobre todo si las personas son mujeres y sedentarias.

ABSTRACT INTRODUCTION In Argentina, obesity in adults is a problem with an average prevalence of 25.4%. The relationship between COVID-19 and obesity shows a higher prevalence of overweight/obesity and severe disease among patients with COVID-19. Therefore, the objective of the study was to know the clinical and epidemiological characteristics of patients diagnosed with obesity who survived SARSCoV- 2 infection. METHODS A descriptive and analytical cross-sectional observational study was carried out. A self-administered survey was applied. RESULTS The median age was 41 years and 69.9% were women. The most prevalent presenting symptoms were asthenia (86.7%), anosmia (64.5%) and cough (64%). Regarding persistent symptoms 12 weeks after diagnosis, the most prevalent ones were asthenia (52.9%), sleep disorders (32.4%) and lack of concentration/memory (31.7%). The risk was higher for women (OR: 2.865; CI95%: 2.23-3.67) with obesity (OR: 1.58; CI95%: 1.16-2.16). Severe disease in obese was almost threefold that in non-obese patients (15.7% vs. 5.4%; p<0.001). DISCUSSION Obese patients showed presenting symptoms that point to a systemic inflammatory state, with dyspnea and cough being more common, and have a higher prevalence of severe disease and pneumonia, as well as a higher risk of developing persistent symptoms, especially if they are women and sedentary.

ABSTRACT This study aimed to describe and compare the body composition (SMM and body fat), handgrip strength, and countermovement jump (CMJ) between young and older females. A descriptive-comparative study, which evaluated 101 females distributed in: older physically active females (Old-PA; n= 26); older physically inactive females (Old-PI; n= 25); young physically active females (You-PA; n= 25) and; young physically inactive females (You-PI; n= 25). Anthropometry, body composition, handgrip strength, relative strength, and CMJ were assessed following previous recommendations. The main results indicate that the Old-PA have greater SMM and body fat compared to Old-PI (p< .01), and You-PA vs. You-PI and Old-PA (p< .01). The You-PA had a higher handgrip strength (p< .01) than the Old-PA, You-PI, and Old-PI. The Old-PA showed a higher handgrip strength vs Old-PI (p< .01). The Old-PA presented a higher relative strength vs Old-PI (p< .01), the You-PA vs You-PI (p< .01), and the You-PA vs Old-PI (p< .01). The Old-PA have a higher height in CMJ compared to the Old-PI (p< .01), You-PA vs. You-PI (p< .01), and Old-PA vs. You-PI (p< .01). The physically inactive condition is related to decreases in SMM, handgrip strength and CMJ in young and older females.

Resumen Presentamos el caso de un varón de 75 años con antecedente de COVID-19 e infarto esplénico tratado con enoxaparina, quien inició con dolor abdominal intenso y hallazgos tomográficos de líquido libre periesplénico, así como una imagen hiperdensa en el bazo. Fue sometido a laparotomía de urgencia, encontrando una ruptura esplénica a nivel del hilio vascular. La ruptura esplénica espontánea es una condición rara y potencialmente fatal, por lo que se deberá tener un alto índice de sospecha ante un paciente con antecedente de COVID-19 que inicie con dolor abdominal agudo posterior a la administración de heparina.

Abstract We present the case of a 75-year-old man with a history of COVID-19 and splenic infarct treated with enoxaparin, who presented with intense abdominal pain and tomographic findings of free peri-splenic fluid and a hyperdense image in the spleen. An emergency laparotomy was performed, with findings of a splenic rupture at the vascular hilum. Spontaneous splenic rupture is a rare and fatal entity that should be suspected in a patient with history of COVID-19 who presents with acute abdominal pain after the administration of heparin.

Resumen Objetivo: Comparar el poder discriminativo y precisión diagnóstica de Eventos Cardiovasculares Mayores (ECVM) de cinco escalas de clasificación de dolor torácico de uso común en pacientes mexicanos con dolor torácico que acuden al servicio de urgencias. Métodos: Estudio prospectivo, observacional y comparativo que incluyó a pacientes ingresados en urgencias que presentaban dolor torácico como síntoma cardinal. Se calcularon cinco escalas de puntuación de dolor torácico. El desenlance principal fue el compuesto de muerte cardiovascular, infarto de miocardio, intervención coronaria, injerto de derivación de arteria coronaria o reingreso por causas cardiovasculares dentro de los 30 días. Resultados: Se estudió un total de 168 pacientes. La escala de puntuación que proporcionó el área bajo la curva más alta de 0.76 (IC de 95%: 0.70-0.85) fue la escala de historia clínica, ECG, edad, factores de riesgo y troponina (HEART, por sus siglas en inglés). Además, el indice de discriminación efectiva para la puntuación HEART fue un 6% más alto en comparación con las otras cuatro escalas de puntuación. Conclusiones: La escala de HEART proporcionó la mejor herramienta de clasificación para idenfiticar a los pacientes con mayor riesgo de ECVM, ya sea solo a agregando sus resultados a otros puntajes de clasificación, incluso en una población comórbida.

Abstract Objective: The aim of the study was to compare the discriminative power and accuracy for prediction of MACE of five commonly used scoring tools in Mexican patients with chest pain who present to the ED. Methods: A single-center, prospective, observational, and comparative study of patients admitted to the ED with chest pain as the chief complaint. Five chest pain scoring systems were calculated. The primary endpoint was the composite of cardiovascular death, myocardial infarction, coronary intervention, coronary artery bypass grafting, or readmission for cardiovascular causes within 30 days. Results: A total of 168 patients were studied. The score which provided the highest area under the curve of 0.76 (95% CI: 0.70-0.85) was history, ECG, age, risk factors, and troponin (HEART) score. In addition, the integrated discrimination index for the HEART score was 6% higher when compared to the other four scores. Conclusions: The HEART score provided the best classification tool for identifying those patients at highest risk for MACE, either alone or by adding their results to other classification scores, even in a comorbid population.