Medicina Clinica Practica最新文献

Objective

To determine if the Glasgow Prognostic Scale (EPG) is a predictor of mortality in critically ill cancer patients at the Instituto Especializado en Enfermedades Neoplásicas (IREN), Trujillo, Peru during 2022.

Material and methods

A cohort study was carried out. retrospective with 191 patients who were admitted to the Intensive Care Unit (ICU) of IREN, Trujillo, Peru during the previous 3 years. Clinical and laboratory variables, EPG and their association with mortality were evaluated through chi2, T-Student and multivariate analysis with binomial logistic regression.

Results

Of the 191 patients included in the study, 100 died (52.4%), with a mean age of 62.7 years and 51% were female. The variables that were associated with mortality in the multivariate analysis were BMI, days spent in the ICU, hemoglobin, and LDH.

Conclusions

The LDH component of the EPG is associated with mortality in critical cancer patients. In addition, they are variables associated with mortality, BMI, days of stay in the ICU, hemoglobin.

Obstructive sleep apnoea syndrome (O-SAS) induces excessive activity of the sympathetic nervous system, resulting in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first-line therapy for O-SAS, poor adherence to CPAP induces uncontrollable resistant hypertension. We present a case of O-SAS-related hypertension successfully treated with sacubitril/valsartan alone. Polysomnography before treatment showed a markedly increased apnoea-hypopnoea index (44.8/hour). While receiving treatment with CPAP and azilsartan, his in-office blood pressure remained within the acceptable range (120–130/80–85 mmHg). However, his blood pressure increased again after quitting CPAP. Subsequently, we switched to sacubitril/valsartan alone and succeeded in improving his blood pressure from 145/95 to 120/80 mmHg. Furthermore, sacubitril/valsartan improved sleep quality in terms of blood pressure (from non-dipper type to dipper type) and apnoea-hypopnoea index (38.3/hour). This case indicates that sacubitril/valsartan has great potential for antihypertensive effects in patients with severe O-SAS, even without CPAP.

Diabetes is currently the leading cause of chronic kidney disease and end-stage renal disease worldwide. Diabetic kidney disease is a complex and heterogeneous disease with numerous overlapping etiologic pathways leading to kidney damage.

We present the case of a 57-year-old man suffering from multiple diseases and cardiovascular risk factors with stage IIIb chronic renal failure with proteinuria close to 3 g/24 h. A complete study of the entity was carried out, ruling out systemic, hematological and/or urological aetiology, nor was the presence of secondary hypertension evident, with control of the same by means of quadruple therapy. Despite comprehensive hygienic-dietary and pharmacological management, no clinical improvement or control of the nephropathy was achieved. It was decided to reinforce treatment with subcutaneous semaglutide, with a very good metabolic response together with significant improvement in proteinuria and stabilization of renal function: both maintained during follow-up. The relevance of this case does not lie in the diagnostic difficulty or in being considered a atypical case, but rather in the existence of new therapeutic weapons that could alter the prognosis of the entity with a drastic reduction in cardiovascular morbidity and mortality and entry into renal replacement therapy.

Introduction

COVID-19 is a disease that affects the respiratory tract and can potentialy lead to multiple organ failure and death. Due to its the high mortality, different prognostic indexes have been proposed in order to indentify which patients are more prone to develope complications and death. We aimed to determine if BNP, wich is a peptide hormone used as an indicator of heart failure and as a prognostic factor in patients with septic shock, may be used as well as a prognostic factor in patients with COVID-19.

Materials and methods

A retrospective case-control study was carried out at a single medical center, including 100 patients with SARS-CoV-2 infection diagnosed by PCR-RT. From the electronic clinical récords, data was obtained in order to compare survivors with the died patients in terms of blood BNP levels.

Results

Of the 100 patients studied, 50 were discharged home and 50 died during their hospital stay. There was a statistically significant difference between both groups regarding age, male gender, oxygen saturation, leukocyte and neutrophil count, lactic dehydrogenase, and C-reactive protein. Regarding BNP, it was found that a cut-off point > 32 pg/ml can be used as a predictor of in-hospital mortality (AUC 0.751) with a sensibility of 60% and sensitivity of 90%; as well as an odds ratio of 13.5 (95% CI; 4.6–39.9).

Discussion

An admission BNP level > 32 pg/ml is associated with a higher in-hospital mortality in patients with COVID-19 and can be considered as a prognostic factor for this disease.

Purpose

Many children do not cooperate for their dental work. Therefore, there would be a delay in dental treatments and cause severe pain and even loss of some teeth. The present study was conducted to compare the knowledge and attitudes of final year students and that of general dentists toward the use of anesthesia in pediatric dentistry.

Methods

This descriptive cross-sectional study was performed on 77 individuals in 2 groups (38 final year dental students and 39 general dentists) in Ahvaz. Data were collected using a questionnaire consisting of 3 sections of demographic data, questions related to knowledge of general anesthesia (including 20 indicators with yes or no answers), and those related to attitude (including 20 items with completely agree, agree, disagree, and completely disagree answers). Comparing the knowledge and attitudes of the studied groups regarding the use of anesthesia and providing the necessary solutions for the optimal and correct use presented. SPSS was used to analyze the obtained data.

Results

The present study showed that students and dentists had intermediate knowledge and attitude about the use of general anesthesia in pediatric dentistry, its complications, and its indications. However, they expressed concerns about the complications of general anesthesia or the lack of sufficient information provided by the dental education system to students.

Conclusion

It is necessary to review the educational curriculum to increase students' information and equip dental schools, anesthesia facilities, and provide courses for general dentists.

Background

Emotional intelligence means the "ability" of a person to express, recognize, and manage "emotions" in themselves and others. Self-confidence means seeing oneself as capable, competent, lovable, and unique. Emotional intelligence can be effective in advancing goals for a person. Academic performance is one of the important indicators in student evaluation, which can also measure the extent to which a person has achieved the goal of acquiring knowledge. The aim of this study was to investigate the emotional intelligence of paramedical students of Hamedan University of Medical Sciences and its relationship with their academic  performance.

Methods

The present study is a cross-sectional study of correlation. And it was done on 300 students of the School of Medical Sciences, who have passed at least two semesters of their studies and were selected by random sampling. In this study, students' demographic information was collected and Shering's standard questionnaire was used for emotional intelligence, Rosenberg's self-esteem questionnaire was used.

Results

There was a positive and significant relationship between students' academic performance and self-esteem (p ≥ 0.01). The results of the study also showed that there was no significant relationship between students' academic performance and emotional intelligence (p = 0.01).

Conclusion

The results of our research showed that among the predicted variables, only self-esteem was able to predict academic performance in students. Self-esteem is the best predictor of academic performance.