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.

Background

Rapid tests for diagnosing Chlamydia trachomatis infection can facilitate patient treatment and reduce transmission, as patients can receive treatment during the same visit. This study aims to evaluate the performance of the rapid test compared to the PCR test for diagnosing C. trachomatis infection to assess its clinical applicability.

Methods

A cross-sectional study was conducted on participants aged > 18 years with symptoms of genital discharge. The performance of the rapid test was evaluated using the PCR test as the gold-standard.

Results

A total of 196 eligible patients were selected for the study. Females accounted for 68.4%, and those aged over 25 years represented 73.0% of the total. The prevalence of C. trachomatis infection was 14.3%. The overall return rate was 41.8%. The Chlamydia rapid test demonstrated a sensitivity of 53.6% (95% CI: 46.6–60.5%), specificity of 86.3% (95% CI: 81.5–91.1%), positive-predictive value of 39.5% (95% CI: 32.6–46.3%), and negative-predictive value of 91.8% (95% CI: 87.9–95.6%). The sensitivity of the rapid test was significantly higher in females, ≥ 25 years, those with past STIs, and symptoms including pruritus, dysuria, and purulent discharge than their counterparts (p < .05).

Conclusion

While the Chlamydia rapid test is less sensitive than the PCR test, it is easy to implement, cost-effective, provides quick results, and allows more patients to receive treatment during the same visit compared to the PCR test. The rapid test still holds value in managing C. trachomatis infection in resource-limited settings, particularly with a low return rate.

Technology has become an essential element for the progress of medicine as it applies the scientific knowledge to professional practice. In recent years, it has grown significantly and has occupied important places in medical practice. As a result, it has been raised whether it could aggravate the current process of medical dehumanization experienced that has been repeatedly denounced. In fact, the traditional dilemma arises as to whether medicine is only an applied science that solves strictly biological problems and that the elements of medical humanism could be ignored. This situation is complicated by the widespread access to medical information that patients use to better understand their illnesses. This article analyzes the relationship between new technologies applied to medicine and their influence on medical humanism. It concludes that technology offers a possibility of defining an improved model of doctor-patient relationship if it is implemented considering the principles of traditional medical humanism.