Medicina Clinica Practica最新文献

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.

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.

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.

Innovation and discovery are the drivers of progress in medicine, which is an ever-changing science. Core concepts in current medical practice include patient-centered and high-value care, evidence-based and personalized medicine, and digital health, that is gaining momentum. Rampant progress is seen in technology development, artificial intelligence, machine learning, large language models such as ChatGPT. Their use in medicine has promising perspectives, conditioned by adequate regulations, based on ethical principles and human-rights, to ensure safety of patient data, fact accuracy, and general applicability.

The future of medicine should aim for universal health coverage, facilitated by digital medicine and guided by empathy and compassion. Human interaction will remain a mainstay in medical practice, and ideally technology will provide the much-needed time for doctor–patient bonding. Climate change, cyber security, and access to basic care are some of the challenges to be resolved in the years to come.

Future medical care should find the balance between high tech and high touch and aim to for global availability.

Objectives

The aim is to determine hidden chronic kidney disease (CKD) and its relationship with the appearance of cardiovascular events (CVD) and mortality. Furthermore, the aim is to identify cardiovascular risk factors (CVRF) and calculate the degree of control of diabetes mellitus (DM) type 2 and dyslipidemia (DLP) prior to CVD.

Material and methods

It consists of a retrospective cohort study carried out in the Basic Health Zones (BHZ) of San Agustín, (population of 33,321 users) which consists of the health centers San Agustín, Illes Columbretes, and the auxiliary clinics of Borriol and Raval; and on the other hand, the BHZ of Almassora (25,831 users), calculated in analysis between January 2015 and December 2018. The main variables were CKD, CVD, mortality and CVRFs.

Results

Final sample of 243 patients from two cohorts of 135 without CKD and 99 with CKD (36.4% occult CKD). The HR of developing CVD was 4.28 and mortality was 12.3 in the group with CKD compared to the group without CKD. Regarding the relationship of CVRFs prior to the appearance of CVD, in the cohort with CKD, hypertension (HTA), DLP, and type 2 DM had significant results, compared to the cohort without CKD. Likewise, in the CKD cohort the percentage of DLP control was less than 50.0%, and greater than 66.66% in DM type 2.

Conclusions

It is observed that a third of patients are not diagnosed with CKD, which has a high probability of developing CVD or death. Given the lack of diagnosis, interventions in the control of DLP and DM type 2 are lower.

Introduction and objectives

As a result of the COVID-19 pandemic and the beginning of a full-scale military invasion, the opportunities for conducting offline training at the medical university have significantly decreased. This made it necessary to find mechanisms to ensure the continuity of medical education of students for all disciplines in general and “Hygiene and Ecology” in particular. Another new challenge was introducing a new form of final exams for university graduates, which also required students and teachers to focus on preparing for this format of knowledge control. This defined the objectives of this study to analyze and summarize the peculiarities of preparing international students for taking an objective structured practical (clinical) examination (OSP(C)E-2) in the “Hygiene and Ecology, Healthcare Organization” station, in the context of combined (distance and in-person) learning.

Materials and methods

Informational data on training organization systems, filling of training platforms, video hosting, and messengers, the results of intermediate controls of students’ knowledge during the exam (3rd year) and final module control (6th year), and final graduation control (OSP(C)E-2) are used as research material.

The method of pedagogical analysis and observation, situational analysis, comparative method, content analysis, and methods of variable statistics, including the non-parametric coefficient of Spearman’s rank correlation, Wilcoxon’s T-test (dependent samples), Kendall’s correlation coefficient, were used in the study.

Results

The content of suggested informational resources was analyzed, and the structure of preparational steps for the final exam and organization of learning in the combined form of education were evaluated.

The effectiveness of the proposed measures was proven by the results of the “Hygiene and Ecology, Healthcare Organization” station of the OSP(C)E-2 examination taken by international students. An analysis of the results of the mixed (online and in-person) administration of the OSP(C)E-2 examination by international students showed a 100% pass rate.

Conclusion

The developed steps have helped to make students resilient and to ease the stressful aspects of the transition to distance learning for English-speaking students during the periods of strict containment measures of the coronavirus disease pandemic and safety measures in wartime conditions.

According to all calculated indices using a sufficient set of variable statistics methods, no significant difference in the results between students of online and offline forms of attestation was found. According to Wilcoxon’s W-test (unrelated samples), the difference was not statistically significant; according to Kendall’s correlation coefficient, no correlation was found, as well as according to Spearman’s rank correlation coefficient.

These achiev