ABSTRACT
La lectura crítica desde el punto de vista de la medicina basada en la evidencia es una lectura estructurada que nos permite evaluar la validez y pertinencia de los resultados y la aplicabilidad de un estudio clínico en nuestro paciente. Sin embargo, el nivel de lectura crítica en los médicos residentes es baja, como se ha descrito diversos estudios. En un estudio realizado en médicos residentes de oncología, se encontró un nivel deficiente de lectura crítica de artículos de investigación clínica. Y de la misma forma, se encontró niveles deficientes en residentes de cardiología y medicina familiar. En nuestro país, se desconoce esta situación y lo más probable es que sea deficiente. Motivo por el que elaboramos una pequeña revisión para poder compartir bases prácticas que ayuden al residente de especialidades clínicas aplicar de una manera más sencilla la lectura crítica de estudios clínicos.
Critical reading from the point of view of evidence-based medicine is a structured reading that allows us to evaluate the validity and relevance of the results and the applicability of a clinical study in our patient. However, the level of critical reading in resident physicians is low, as various studies have described. In a study of oncology resident physicians, a poor level of critical reading of clinical research articles was found. And in the same way, deficient levels were found in cardiology and family medicine residents. In our country, this situation is unknown and it is most likely deficient. Reason why we prepared a small review to be able to share practical bases that help the resident of specialties apply in a simpler way the critical reading of clinical studies.
ABSTRACT
Abstract Thromboembolic events are frequent in patients with COVID-19 infection, and no cases of bilateral renal infarctions have been reported. We present the case of a 41-year-old female patient with diabetes mellitus and obesity who attended the emergency department for low back pain, respiratory failure associated with COVID-19 pneumonia, diabetic ketoacidosis, and shock. The patient had acute kidney injury and required hemodialysis. Contrast abdominal tomography showed bilateral renal infarction and anticoagulation was started. Kidney infarction cases require high diagnostic suspicion and possibility of starting anticoagulation.
Resumo Fenômenos tromboembólicos são frequentes em pacientes com infecção por COVID-19 e nenhum caso de infarto renal bilateral havia sido relatado. Apresentamos o caso de uma paciente do sexo feminino, de 41 anos, com diabetes mellitus e obesidade, que deu entrada no serviço de urgência por lombalgia, insuficiência respiratória associada à pneumonia COVID-19, cetoacidose diabética e choque. A paciente apresentava lesão renal aguda e demandava hemodiálise. A tomografia abdominal contrastada mostrou infarto renal bilateral e foi iniciada anticoagulação. Os casos de infarto renal requerem alta suspeita diagnóstica e possibilidade de iniciar a anticoagulação.
Subject(s)
Humans , Female , Adult , Diabetes Complications , Acute Kidney Injury/complications , COVID-19/complications , Infarction/complications , Kidney/blood supply , Obesity/complications , Respiratory Insufficiency/complications , Severity of Illness Index , Immunoglobulin M/blood , Tomography, X-Ray Computed , Renal Dialysis/methods , Fatal Outcome , Acute Kidney Injury/therapy , SARS-CoV-2/immunology , COVID-19/drug therapy , COVID-19/virology , Antibodies, Viral/blood , Anticoagulants/therapeutic useABSTRACT
RESUMEN Objetivo: Determinar la prevalencia, características clínicas y evolución de los pacientes y personal asistencial con infección por COVID-19 en un centro de hemodiálisis de referencia nacional. Metodología: Estudio observacional y retrospectivo en una cohorte de pacientes en hemodiálisis crónicay del personal asistencial con infección por COVID-19 del Hospital Nacional Dos de Mayo de Lima desde el 1° de marzo al 12 de junio del 2020. Resultados:Se evaluó a 48 pacientes y a 52 miembros del personal asistencial. El 33,3% de los pacientes y el 7,6% del personal asistencial fue positivo para COVID-19. El 56,2% de los pacientes fueron sintomáticos y el 18,7% requirió hospitalización. Nadie del personal asistencial tuvo síntomas. A la fecha, ninguno de los pacientes evaluados ha requerido ventilación mecánica o ha fallecido.Conclusiones: La infección por COVID-19 entre pacientes es alta. Dos de cada diez han requerido hospitalización, sin ningún fallecido.
ABSTRACT Objective: To determine the prevalence, clinical characteristics, and evolution of the patients and healthcare staff with COVID-19 infection in a national reference hemodialysis center.Methodology. Observational and retrospective study in a cohort of patients on chronic hemodialysis and healthcare staff with COVID-19 infection at the Dos de Mayo National Hospital in Lima from March 1 to June 12, 2020. Results. Were evaluated 48 patients and 52 healthcare staff. Were positive for COVID-19 33.3% of patients and 7.6% of healthcare staff. Were symptomatic 56.2% of the patients and 18.7% required hospitalization. No one on the staff had symptoms. To date, none of the patients evaluated has required mechanical ventilation or has died. Conclusions. COVID-19 infection among patients is high. Two out of ten patients have required hospitalization, without any deceased.