Revista Medica Clinica Las Condes最新文献

Background

The COVID-19 pandemic led to an increase in distance learning for undergraduate medical students. Reports on these experiences have been published but research regarding student perception of these new learning methods is still lacking. Finis Terrae University implemented an online modality in 2021 and a hybrid modality in 2022 for their undergraduate Orthopedics course.

Aim

The objective of our work is to determine the perception of fifth year medical students with regards to the hybrid 2022 Orthopedics course.

Methodology

A student satisfaction survey was conducted assessing the following dimensions: concept and previous experience with distance classes; perception of distance learning and face-to-face practice; limitations of distance education; and rating with regards to maintaining teaching said methodology.

Results

All students (92/92) responded to the survey. The group was made up of 53% women and 47% men, with a median age of 24 [22-37] years. Most of the students reported that the course met their expectations and that they had a good acquisition of theoretical knowledge, although they had insecurity in the application of the physical examination. Advantages and disadvantages of this modality were recognized and improvements were suggested.

Conclusions

This study supports favorable student perception regarding an adequate acquisition of theoretical knowledge, the advantages of the hybrid modality and the positive evaluation. However, improvement in terms of the acquisition of training in physical examination and time allocation for the Orthopedics course.

Clinical case

A 42-year-old woman, a smoker since her twenties, without any personal, family or traumatic history of interest. Currently, she consults with a cold like symptoms with fever that has lasted for several days. She had right chest and abdominal pain without dyspnea, with pleuritic characteristics. refractory to ibuprofen.

Results

A chest x-ray was performed showing several pulmonary micronodules, which, added to her smoking history and refractory thoraco-abdominal pain, prompted a thoraco-abdomino-pelvic computerized tomography (CT). On CT, the pulmonary micronodular images do not appear to have a malignant behavior, but since they are associated with multiple enostotic infiltrative osteosclerotic lesions in the axial skeleton (incidentally seen on thoraco-abdomino-pelvic CT with bone window), their better characterization with a metabolic study is recommended, given the reasonable suspicion of bone metastases secondary to lung cancer. In the metabolic/functional extension study, a global hypouptake was obtained, reasonably ruling out the possibility of bone metastases, and directing diagnostic suspicions towards other benign possibilities such osteopoikilosis.

Conclusions

Osteopoikilosis is a casual and rare finding that should be included in the differential diagnosis of multiple osteosclerotic images, and not be confused with malignant entities.

COVID-19 had a wide spectrum of clinical manifestations, from asymptomatic to severe forms. A significant percentage of infected subjects develop acute respiratory distress syndrome (ARDS).

Objective

Use of prone position and airway pressure release ventilation (APRV) to improve oxygenation in a patient with COVID-19 ARDS.

Clinical case

73-year-old patient, with diabetes and high blood pressure, presented with a diagnosis of severe COVID-19 pneumonia, which required the use of invasive mechanical ventilation (IMV). In the context of poor oxygenation, difficult sedation and blood gas deterioration, APRV is started. With the progression of pulmonary involvement, ventilatory strategies were not very fruitful, so it was decided to use prone + APRV.

Results

a total of 574 hours in IMV and 274 hours in prone divided into 3 cycles of duration. The first cycles of prone + APRV were relevant in terms of improvements in PaO₂/FiO₂ (PaFi), however, from the third prone event, there were no significant changes.

Conclusions

prone + APRV was adequate to the patient's requirements, however, the clinical course of the disease produced irreversible deterioration.

Bronchiectasis is a chronic inflammatory disease of the airways that is manifested by chronic cough, mucosal o mucopurulent bronchorrhea, and recurrent exacerbations. Its etiology is varied, but it is essential within its study to try to identify the cause to avoid progressive lung damage, a product of the so-called “vicious circle” with recurrent infections, inflammation and permanent structural damage. The diagnosis is clinical and must be confirmed by performing a high-resolution chest computed tomography. Therapeutic management should be aimed at controlling infection and bronchial inflammation, as well as managing associated complications and comorbidities.

Vaccines are synthetic biological products designed for the prevention of infectious diseases. After potable drinking water, they are the most effective public health measure in reducing mortality and other consequences caused by vaccine-preventable diseases. In Chile, they accompany us throughout our life cycle through the National Immunization Program (PNI), created in 1979 and constantly undergoing change and improvements in order to ensure safe and free access to vaccines to the general population. There are certain clinical conditions, however, that exacerbate the acquisition and/or severity of vaccine-preventable diseases. These special populations are on the rise. In this context, the objective of this review is to provide current guidelines for the immunization of these particular groups of patients.

Bronchial asthma is considered one of the most common chronic pathologies in pregnancy, affecting between 6 to 10% of pregnant women according to international reports. In this group of patients, approximately one third will present a significant aggravation in asthma symptoms, exposing the mother and fetus to a high risk of exacerbations and use of systemic corticosteroids. Poor control of asthma symptoms is in many cases due to suspension or suboptimal therapy with inhaled corticosteroid, which constitutes the basis of anti-inflammatory and controller therapy in asthma. It has been shown that poorly controlled asthma during pregnancy increases the risk of obstetric complications. The respiratory management of these patients must be proactive, patient education based and with informed use of anti-asthmatic treatments, which are highly effective and, for most patients, easily accessible. This article will review the pathophysiology, diagnosis and pharmacological management of asthma in pregnancy.

The diagnostic approach in patients with pleural effusion requires considering clinical aspects, fluid analysis, and, often, pleural biopsy. Currently, several procedures con be performed at the same time to speed up the diagnostic process, ideally in an outpatient setting. This article aims to describe the state of the art with regards to the diagnostic process.

The administration of drugs via inhalation has become the primary route for treating obstructive pulmonary diseases. In this context, the efficient deposition of medication particles in the airway plays a fundamental role in the effectiveness of inhaled therapy, offering superior benefits in terms of speed and reduction of systemic effects compared to other routes of administration. It is crucial to ensure that a sufficient amount of medication reaches beyond the oropharyngeal region to guarantee therapeutic effectiveness. Among the available devices for this form of administration, pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) are the most commonly used. It is worth mentioning that nebulization devices are not covered in this review.

Although the diversity of therapeutic options is beneficial, the availability of different devices can create some complexity when instructing patients on their proper use. Consequently, it is vital for patients to precisely follow the recommended inhalation technique. Errors in device handling can lead to improper drug distribution, reducing the effective dose and compromising treatment efficacy. This review provides detailed explanations of the mechanism of action of these devices, as well as practical instructions for patient care personnel. Emphasis is placed on the importance of correct inhalation technique to maximize treatment efficacy and ensure optimal drug use.

The influenza A(H1N1) pandemic of 2009 marked a pivotal event in the 21st century, as it was recognized as the first pandemic of that era, once again highlighting the vulnerability of populations to respiratory viruses. This article aims to explore the lessons learned from the Influenza A H1N1 pandemic, particularly pertinent to the current epidemiological landscape. Viral characteristics, pathogenesis, clinical symptoms, and associated risk factors were analyzed. Additionally, the significance of early antiviral therapy, potential adverse effects linked to corticosteroid use, and non-viral infectious complications, such as necrotizing pneumonia caused by Staphylococcus aureus and streptococcal toxic shock syndrome, were examined. This review aspires to be a valuable resource for understanding and addressing influenza-induced pneumonia and its complications from prevention to treatment.

Connective tissue diseases and vasculitis are a wide group of autoimmune pathologies that can affect multiple organs. One of the most frequently affected systems is the respiratory system, with compromise of the airway, lung parenchyma, pleura and mediastinum. These pathologies constitute an important cause of morbimortality, making it essencial to maintain a high clinical suspicion.

Furthermore, it is of vital relevance to rule out other causes of affectation like adverse drug reactions and infections due to the immunosuppressed state of patients with rheumatic diseases.

Both the classification and its management must be done by a multidisciplinary team, based on the clinical history, serology, lung function tests, high-resolution computed tomography, bronchoalveolar lavage and/or biopsy, depending on each case.

This review article aims to highlight the importance of a multidisciplinary approach in the management of connective tissue diseases and vasculitis; complex pathologies that can affect the respiratory system, constituting an important cause of morbidity and mortality. The classification and management of these conditions should be carried out by a multidisciplinary team, based on clinical status, laboratory tests, pulmonary function tests, imaging studies, and biopsies, according to each case.