Medicina Clinica Practica最新文献

Introduction

The clinical characteristics and treatment received by patients hospitalized with COVID-19 have changed over time. The objective was to analyze the clinicaltherapeutic evolution of patients in the epidemic waves and estimate a predictive model for mortality.

Methods

Retrospective cross-sectional study considering patients admitted with confirmed SARS-CoV-2 infection until March 2022. Sociodemographic variables, comorbidities and treatments were collected and a predictive model for mortality was created using multivariate logistic regression.

Results

1,784 patients were included. Significant differences were found between the epidemic waves with respect to age, sex, arterial hypertension, diabetes mellitus, obesity and chronic kidney disease. Ceftriaxone, azithromycin, hydroxychloroquine, methylprednisolone and lopinavir-ritonavir were the most frequently used drugs in the first wave. Amoxicillin, dexamethasone and tocilizumab were prescribed more frequently in successive waves. The percentage of deaths varied from 5.6% in the fourth wave to 14.1% in the third (p < 0.001). The resulting factors associated with mortality (OR; 95% CI) were ICU admission (56.5; 27.4-121), age (1.09; 1.08-1.11), days of admission (0.98; 0.96-0.99), chronic kidney disease (1.67; 1.16-2.40) and having received treatment with tocilizumab (2.49; 1.43-4.30), dexamethasone (1.58; 1.10-2.26) and methylprednisolone (2.46; 1.63-3.68). The area under the curve achieved by the model was 0.863.

Conclusion

There are significant clinical-therapeutic differences in patients along the first six epidemic waves. Knowledge of mortality risk factors will allow the detection of hospitalized patients at higher risk and early optimization of their therapeutic management.

Objective

To assess the impact of the alterations of continuity of care on diabetic patients in our health department during the confinement that caused the pandemic. Check whether or not confinement mean tan alteration in the degree of control of our type 2 diabetic patients. Know whether our diabetic patients were adequately coontrolled before the pandemic began. Know if the pandemic has led to a deterioration in its degree of control.

Subject and method

Retrospective study between the years 2019 and 2020 of type 2 diabetic patients in our health area. Through the “Alumbra” application of our health area, a random sample of our patients diagnosed with type 2 diabetes from 18 to 100 years of age was obtained. The patients was informed if they wanted to enter the study and after the patient´s express consent, the patient was asked about their lifestyle, habits and a review of the medical history was carried out with the data recorded before the confinement (year 2019) and during the months of confinement of 2020.

Results

There were 882 patients (88.28%) with HbA1c determinations in 2019 with a mean of 7,08. There were 800 patients (88.98%) with HbA1c deteminations in 2020 with a mean of 7,02. There was a reduction in alcohol, tobacco and soft drink consumption habits, but there was also a reduction in physical exercise (33% to 22%) and is following a diabetic diet (34% to 24%). In the sample analyzed, there was a reduction in a alcohol consumption from the data obtained in 2019 to those obtained in 2020 (22% to 13%). There was an increase in obesity, which goes from 77,7% to 90,4%. It is observed that there is no change in the percentages in pathologies such as dislipemia, atrial fibrilation, osteoarthritis, and stroke.

Conclussion

The consequences associated with the pandemic on health are worrying, the decrease in acute consultation, preventive activities and the delay in controls for chronic patients will have a profound impact on the psychological and socioeconomic well being of populations. The holistic view of the Primary Care and the need to strengthen and rethink the system to increase its effciency are of particular importance.

Burns are the consequence of tissue harm caused by extended exposure to extreme heat, sunlight radiation, other types of radiation, chemicals, or electricity. Burns can vary from minor to life-threatening, and the appropriate treatment depends on the seriousness and location of the burn. Severe and extensive burns necessitate immediate medical attention, and some individuals may need specialized care centers and ongoing medical check-ups for several months. Electric burns occur when the skin is exposed to a weak or strong electric shock, and they can be categorized as mild or severe depending on the length and intensity of the shock. In this case study, we present the treatment of a severe electric burn on a 10-year-old boy's right leg using nano-zinc bandages. The use of these bandages proved to be highly effective in healing the child's injured leg. This case study discusses the treatment of a severe electric burn in a 10-year-old boy using zinc nanoparticles. The authors observed positive outcomes in terms of skin healing after the application of nano-zinc bandages. Zinc nanoparticles have attracted attention due to their antimicrobial properties and ability to aid wound healing. The main significant clinical output is that the case suggests the potential of zinc nanoparticles in aiding wound healing for burns and emphasizing the need for further research on their effectiveness and safety on a larger scale. However, it is important to note that this is a single case study for burning treatments and further research is required to determine the effectiveness and safety of zinc nanoparticles in burn treatment.

Background

The COVID-19 pandemic is attributed to SARS-COV-2 virus rapidly spreading around the world as a global health emergency. The difference in the rate of infection and disease severity has raised doubts about the impact of genetic predisposition on the COVID-19 severity. Previous studies have proposed the relationship between blood group antigens as one of genetic risk factors involved in susceptibility to COVID-19. Herein, we aimed to delve into the association between ABO blood group and COVID-19 infection, severity, and mortality rate.

Methods

In this cohort study, the patients who referred to university-based referral hospital (Hazrat Rasool) in Tehran, Iran, with the positive PCR test for COVID-19 were followed up during 2021. They were classified as: (1) mild, (2) moderate, (3) severe, and (4) death based on disease severity. The demographic information including age, gender, and underlying disease and the patient's medical record such as blood type, intubation, and severity of illness was recorded. Then, the predefined variables were recorded in each group and compared with each other. Finally, the obtained findings were analyzed by SPSS version-22 software.

Results

Overall, 101 patients were included among which 51.5% (52 cases) were male and the rest were female. Their average age was 64.14 ± 16.37 years (ranged from 20 to 94 years). The most common blood group in affected cases was O + (37.6%) and then A + (35.6%). Also, the most underlying disease was hypertension and diabetes with a prevalence of 45.5% and 35.6%, respectively. 66.3% of cases died and 76.2% and 22.8% of cases presented severe and moderate form of COVID19, respectively. The average hospitalization time was 19.77 ± 18.34 days (the longest time of 150 days) compared to the 12.79 ± 10.45 days in ICU (the longest time of 55 days). In addition, the most common blood group amongst the hospitalized cases was O + which were significantly associated with the lower severity and mortality rate of COVID19 (p-value ≤ .0001).

Conclusions

The findings of current study suggest that A + blood group might be more susceptible to COVID-19 with significantly higher severity or mortality rate of disease while O + blood group might be less susceptible with longer survival and less severity of disease. Our results add to the growing body of evidences suggesting the blood group types may pave the way for early preventive measures and management approaches of COVID-19.