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Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

Resumen Objetivo Determinar la incidencia de la mortalidad perioperatoria asociada a nefrectomia radical en pacientes con tumores renales y sus factores asociados en un hospital de tercer nivel. Materiales y metodos Se realizo un estudio de corte transversal. Se revisaron las historias clinicas de los pacientes sometidos a nefrectomia radical entre el 1 de enero de 2007 y el 31 de diciembre de 2011 en un hospital universitario de tercer nivel (Cali, Colombia). Se midieron las variables sociodemograficas y los factores que pudieran estar asociados a la mortalidad perioperatoria. Se realizo el analisis estadistico en STATA. Resultados Se analizaron 57 pacientes que fueron sometidos a nefrectomia radical, de los cuales el 54,4% fueron hombres, con un rango de edad de 14 a 81 anos. Todos los tumores fueron de presentacion unilateral. El 96,5% eran lesiones renales solidas y el 3,5% lesiones quisticas. Los hallazgos histologicos mas frecuentes fueron carcinoma renal de celulas claras (63,2%), papilar (8,7%) y de celulas cromofobas (5,2%). No se presentaron complicaciones en 27 (47,3%) pacientes. Segun la clasificacion de complicaciones Clavien-Dindo se encontraron complicaciones menores (grados i y ii ) en 16 (28%) pacientes y mayores (grados iii y iv ) en 9 (15,6%) pacientes, con una mortalidad perioperatoria global (grado v ) del 8,7% (5 pacientes). Conclusiones La mortalidad perioperatoria a 30 dias en pacientes sometidos a nefrectomia radical con carcinoma renal no metastasico fue del 4,1% (2 pacientes) en un hospital universitario de tercer nivel en Cali, Colombia.

Objective To determine the incidence and related factors of perioperative mortality associated with radical nephrectomy in patients with renal tumors in a tertiary hospital. Material and methods We conducted a cross-sectional study that reviewed the medical records of patients undergoing radical nephrectomy between January 1, 2007 and December 31, 2011 in a tertiary university hospital (Cali, Colombia). We measured sociodemographic variables and factors that may be associated with perioperative mortality. The statistical analysis was performed using STATA. Results We analyzed 57 patients who underwent radical nephrectomy, 54.4% of whom were male, whose ages ranged from 14 to 81 years. All tumors had a unilateral presentation; 96.5% of the tumors were solid renal lesions, and 3.5% were cystic lesions. The most frequent histological findings were clear cell (63.2%), papillary (8.7%) and chromophobe cell (5.2%) renal carcinoma. There were no complications in 27 (47.3%) of the patients. According to the Clavien–Dindo classification of surgical complications, 16 (28%) patients had minor (grades I and II) complications and 9 (15.6%) had major (grades III and IV) complications, with an overall perioperative mortality (grade V) of 8.7% (5 patients). Conclusions The perioperative mortality at 30 days for patients with nonmetastatic renal carcinoma who underwent radical nephrectomy at a tertiary university hospital in Cali, Colombia was 4.1% (2 patients).

Fundamento Describimos las caracteristicas clinicoepidemiologicas de 19 pacientes diagnosticados de tularemia en nuestro hospital pertenecientes a la aparicion de un brote epidemico en nuestra area asistencial. Metodo Se han revisado retrospectivamente las historias clinicas de los pacientes ingresados en el hospital y examinados en la consulta del Servicio de Infecciosas con clinica y epidemiologia compatible con tularemia durante el periodo de junio de 1998 a marzo de 1999. Criterio de definicion de caso. Paciente con clinica y epidemiologia sugestiva y los siguientes criterios de laboratorio: titulo de anticuerpos frente a Francisella tularensis (aglutinacion en tubo) ≥ a 1/128 en suero convaleciente, seroconversion o aislamiento del microorganismo en material biologico. Resultados Diecinueve pacientes con una mediana de edad de 60 anos, con predominio del sexo masculino (63,1% varones); todos ellos habian manipulado cangrejos rojos de la misma procedencia (rio Mayor); el periodo de incubacion oscila entre 0 y 15 dias (media de 4,88 dias). La forma ulceroglandular ha sido la forma clinica de presentacion en el 100% de los casos. El 73,1% de los pacientes recibio tratamiento con doxiciclina. Solo 1 paciente presento recidiva. Las muestras de agua de las lagunas de drenaje de la depuradora del rio han resultado positivas a F. tularensis por reaccion en cadena de la polimerasa (PCR). Este mismo resultado se ha confirmado en el estomago y hepatopancreas de los cangrejos pescados en el rio Mayor en la segunda quincena de julio. Conclusiones La hipotesis mas probable de este brote es la contaminacion del agua del rio por animales muertos de tularemia, que, junto a las peculiaridades del mecanismo de transmision (heridas por cangrejos), han contribuido a que se contraiga la enfermedad en humanos, con la particularidad de ser los cangrejos rojos la fuente de infeccion.