Objetivos.
Identificar las especialidades preferidas, la percepción salarial y los factores que influencian la elección de una carrera en atención primaria en los estudiantes de último año de ...medicina o en servicio social de América Central.
Métodos.
Estudio multicéntrico de corte transversal con aplicación de una encuesta que investigó la información demográfica, la especialidad preferida, la percepción salarial y otros factores que influyen en la elección de la especialidad.
Resultados.
Participaron 1 722 estudiantes de 31 universidades que identificaron como futuras especialidades: cirugía (11,7%), ginecología/obstetricia (10,3%), pediatría (9,9%) y medicina interna (6,6%). Medicina general alcanzó 3,8% y medicina familiar 1,1%. Al agruparlas el mayor interés fue para las especialidades médicas (49,7%), seguido de las quirúrgicas (31,7%). Atención primaria registró un interés del 17,1%. Las especialidades quirúrgicas fueron percibidas como de mayor ingreso (USD 36 000); atención primaria fue percibida como la de menor ingreso (USD 24 000). El ingreso (23,6%), el trabajo a futuro (19,7%) y “hacer una diferencia en las personas” (8,9%) fueron los principales factores involucrados en la elección. “Trabajar con personas con escaso acceso” se asoció de manera significativa con la preferencia por la atención primaria. La preferencia por otras especialidades fue influenciada por el “prestigio percibido” y “disfrutar la vida” (P < 0,05). La mayoría de los participantes que eligieron la atención primaria provenían de una universidad pública (P < 0,05), lo que pone de relieve el papel de las instituciones estatales de educación superior.
Conclusiones.
Existe una combinación de factores facilitadores y de barreras que inciden en el desinterés hacia las carreras de atención primaria. Se requiere de estrategias desde la academia y el sector gubernamental, así como la definición de políticas públicas, que favorezcan la elección de la atención primaria.
Las decisiones clínicas de los pacientes de la unidad de cuidados intensivos se basan en la integración de la historia clínica y exámenes complementarios. La evaluación ecocardiográfica puede revelar ...información decisiva en las intervenciones y en el pronóstico de los pacientes.
Determinar la concordancia en el análisis de la función sistólica del ventrículo izquierdo realizado por médicos con formación básica en ecocardiografía comparado con la valoración por cardiólogos expertos.
Estudio de corte transversal de concordancia diagnóstica con reclutamiento prospectivo. Se incluyeron pacientes hospitalizados en la unidad de cuidados intensivos durante 2023 en una clínica universitaria de alto nivel de complejidad. La concordancia entre el médico con entrenamiento y el experto se analizó mediante el índice de kappa (κ) para las variables cualitativas, y para las cuantitativas con el coeficiente de correlación intraclase.
Se incluyeron 131 pacientes, con una edad promedio de 62 años. Se determinó la concordancia de la valoración ecocardiográfica, encontrando concordancia muy buena para la contractilidad del ventrículo izquierdo (κ: 0,97), derrame pericárdico (κ:0,82) y su localización (κ: 0,85), trastornos de la contractilidad (κ: 0,84) y en la medición cuantitativa de la fracción de eyección (coeficiente de correlación intraclase: 0,91).
Existe concordancia en la evaluación de la función sistólica del ventrículo izquierdo en pacientes hospitalizados en unidad de cuidados intensivos por el personal médico no experto con entrenamiento y cardiólogos expertos. Los resultados deben interpretarse como parte de una valoración integral a la cabecera del paciente y no como un diagnóstico aislado, siempre bajo estándares de calidad y con la verificación necesaria.
The clinical decisions of patients in the intensive care unit are based on the integration of the clinical history and complementary tests. The echocardiographic evaluation can reveal decisive information in the interventions and in the prognosis of the patients.
To determine the concordance in the analysis of left ventricular systolic function performed by physicians with basic training in echocardiography compared with the assessment by expert cardiologists.
Cross-sectional study of diagnostic concordance with prospective recruitment. Patients hospitalized in the intensive care unit during 2023 in a university clinic with a high level of complexity were included. The concordance between the trained physician and the expert was analyzed using the Kappa index (κ) for the qualitative variables, and the intraclass correlation coefficient for the quantitative ones.
131 patients were included, with a mean age of 62 years. The concordance of the echocardiographic assessment was determined, finding very good concordance for left ventricular contractility (κ: 0.97), pericardial effusion (κ: 0.82) and its location (κ: 0.85), contractility disorders (κ: 0.84) and in the quantitative measurement of the ejection fraction (intraclass correlation coefficient: 0.91).
There is agreement in the evaluation of left ventricular systolic function in patients hospitalized in the intensive care unit by non-expert medical personnel with training and expert cardiologists. The results should be interpreted as part of a comprehensive assessment at the patient's bedside and not as an isolated diagnosis, always under quality standards and with the necessary verification.
OBJECTIVEThe aim of this study was to analyze the prognosis of patients presenting early ventricular fibrillation (VF) in the setting of ST elevation myocardial infarction (STEMI).
PATIENTS AND ...METHODSAmong patients included in the ARIAM (Análisis del Retraso en el Infarto Agudo de Miocardio) registry with the diagnosis of STEMI, those who received primary revascularization and were admitted in the first 12 h were analyzed retrospectively.
RESULTSFrom January 2007 to January 2012, 8340 patients were included in the STEMI cohort and 680 (8.2%) of them presented with VF before admission to the ICU (VF). This group comprised younger patients with fewer comorbidities. They received more often primary angioplasty (33.7 vs. 24.9%; P<0.001), had more prevalence of Killip class greater than or equal to 2 at admission (37.5 vs. 17.8%; P<0.001), and suffered more often cardiogenic shock (18.5 vs. 5.9%, P<0.001). By logistic regression analysis, VF was associated with a greater in-hospital mortality odds rate (OR)2.08, 95% confidence interval (CI)1.57–2.81, P<0.001. After a propensity score matching process, VF was associated with in-hospital mortality (OR1.53, 95% CI1.05–2.25, P=0.028). However, when analyzing patients treated by primary angioplasty, the mortality was not significantly related to VF (OR0.86, 95% CI0.45–1.61, P=0.628).
CONCLUSIONOur results show that VF before ICU admission was an independent predictor of in-hospital outcome in a cohort of patients in whom fibrinolysis was the most used revascularization therapy. However, this prognostic value was not found in patients treated with primary angioplasty.
El síndrome compartimental agudo del miembro inferior es una urgencia médica, que puede conllevar una importante morbilidad para el paciente y que puede tener implicaciones medicolegales para el ...personal médico. Afecta cerca de 3,1 por 100.000 habitantes en el mundo occidental, con predominio de hombres y jóvenes. Debido a una alteración de la perfusión tisular, por la disposición de los músculos de las extremidades en compartimientos compactos, con poca tolerancia a variaciones en la presión, puede causar isquemia, con cambios irreversibles a nivel muscular y nervioso, falla multiorgánica y la muerte, de no tratarse oportunamente.
El trauma de la extremidad inferior asociado a fractura es la principal causa del síndrome compartimental agudo. El diagnóstico puede realizarse por evaluación clínica, mediante las clásicas seis “P” de la isquemia, u de manera objetiva, al medir la presión intracompartimental con dispositivos especializados. La fasciotomía descompresiva es un procedimiento quirúrgico mediante el cual se inciden las fascias de los compartimientos musculares, permitiendo la disminución de las presiones a ese nivel, y se constituye en el único tratamiento eficaz para el síndrome compartimental agudo. Las complicaciones posquirúrgicas no son infrecuentes, siendo la perdida de la extremidad la más grave de todas. Un correcto conocimiento y aplicación de la técnica quirúrgica evitará procedimientos inadecuados, que impliquen mayor riesgo de resultados adversos.
Presentamos una revisión de los aspectos fundamentales de esta patología potencialmente catastrófica.
Chemotherapy-induced peripheral neuropathy is a common adverse reaction in a variety of medications frequently used for a great number of cancer treatments. This condition consists of mainly ...sensory-type symptoms, motor components and autonomic changes. Reported prevalence ranges from 30-68%, after the completion of chemotherapy in non-Latin American people with different populations and socioeconomic levels.
To determine the prevalence of chemotherapy-induced peripheral neuropathy in a Colombian population.
A real-world evidence cross-sectional retrospective study was performed in all patients from oncological clinical centers in Colombia, which received pharmacological therapy for any cancer between January 2015 and December 2016, with taxanes (paclitaxel, docetaxel), alkylators (oxaliplatin), proteasome inhibitors (bortezomib), and epothilone B analogs (ixabepilone).
A total of 1,551 patients in four cities were included, and 11,280 doses were applied; predominantly females (n = 1,094; 70.5%), with a mean age of 57 ± 13 years old. Paclitaxel was the most commonly prescribed drug (n = 788; 50.8%). Chemotherapy-induced peripheral neuropathy was developed in 48.9% of paclitaxel, 58.5% of oxaliplatin, 50.5% of docetaxel, 43.7% of bortezomib and 95.2% of ixabepilone patients. Thirty-three patients were treated with two of these medications simultaneously.
Chemotherapy-induced peripheral neuropathy is a frequent adverse reaction to daily cancer therapy in Colombian patients managed with taxanes, alkylators, proteasome inhibitors, and epothilone B analogs. Hence, it is necessary to establish more successful diagnostic methods and incorporate validated scales in the routine evaluation of all patients receiving these medications in our environment.
In order to evaluate the pharmacokinetics of metamizol in the presence of morphine in arthritic rats, after subcutaneous administration of the drugs, an easy, rapid, sensitive and selective ...analytical method was proposed and validated. The four main metamizol metabolites (4-methylaminoantipyrine, 4-aminoantipyrine, 4-acetylaminoantipyrine and 4-formylaminoantipyrine) were extracted from plasma samples (50–100μl) by a single solid-phase extraction method prior to reverse-phase high performance liquid chromatography with diode-array detection. Standard calibration graphs for all metabolites were linear within a range of 1–100μg/ml (r2≥0.99). The intra-day coefficients of variation (CV) were in the range of 1.3–8.4% and the inter-day CV ranged from 1.5 to 8.4%. The intra-day assay accuracy was in the range of 0.6–9.6% and the inter-day assay accuracy ranged from 0.9 to 7.5% of relative error. The lower limit of quantification was 1μg/ml for all metabolites using a plasma sample of 100μl. Plasma samples were stable at least for 4 weeks at −20°C. This method was found to be suitable for studying metamizol metabolites pharmacokinetics in arthritic rats, after simultaneous administration of metamizol and morphine, in single dose.
Adherence to tuberculosis (TB) treatment is troublesome, due to long therapy duration, quick therapeutic response which allows the patient to disregard about the rest of their treatment and the lack ...of motivation on behalf of the patient for improved. The objective of this study was to develop and validate a scoring system to predict the probability of lost to follow-up outcome in TB patients as a way to identify patients suitable for directly observed treatments (DOT) and other interventions to improve adherence.
Two prospective cohorts, were used to develop and validate a logistic regression model. A scoring system was constructed, based on the coefficients of factors associated with a lost to follow-up outcome. The probability of lost to follow-up outcome associated with each score was calculated. Predictions in both cohorts were tested using receiver operating characteristic curves (ROC).
The best model to predict lost to follow-up outcome included the following characteristics: immigration (1 point value), living alone (1 point) or in an institution (2 points), previous anti-TB treatment (2 points), poor patient understanding (2 points), intravenous drugs use (IDU) (4 points) or unknown IDU status (1 point). Scores of 0, 1, 2, 3, 4 and 5 points were associated with a lost to follow-up probability of 2,2% 5,4% 9,9%, 16,4%, 15%, and 28%, respectively. The ROC curve for the validation group demonstrated a good fit (AUC: 0,67 95% CI; 0,65-0,70).
This model has a good capacity to predict a lost to follow-up outcome. Its use could help TB Programs to determine which patients are good candidates for DOT and other strategies to improve TB treatment adherence.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
