ABSTRACT
Introduction: Chronic kidney disease (CKD) and the number of transgender people is on the rise. Hormone replacement therapy may be associated with the development of adverse effects, including kidney disease. Objective: To report the case of a transgender patient using hormone therapy who developed CKD. Case Report: Male transgender patient, 28 years old, using testosterone cypionate every 15 days, without any comorbidity. Evolved with hypertensive peaks of 160-150/110 mmHg and loss of kidney function (Ur 102 mg/dl, Cr 3.5 mg/dl, estimated Glomerular Filtration Rate (eGFR) of 22 ml/min/1.73m2 considering male gender and 16.6 ml/min/1.73m2 considering female gender). Abdominal ultrasound showed chronic parenchymal nephropathy. Due to the significant reduction in eGFR, the patient was referred for kidney transplantation, but he was not included in the list because he had a creatinine clearance of 23 ml/min/1.73m2 for males and 21.5 ml/min/1.73m2 for females in the most recent tests. Conclusion: Hormone replacement may have contributed to the increase in the patient's blood pressure and, consequently, to the development of CKD. There is still no well-established consensus on the best way to estimate the GFR in transgender people, and it seems to be more appropriate to consider the gender to which the person self-identifies or to perform the calculation for both genders, obtaining an estimate of the range in which the patient's GFR lies.
Subject(s)
Renal Insufficiency, Chronic , Transgender Persons , Adult , Creatinine , Cystatin C , Female , Glomerular Filtration Rate , Hormones , Humans , MaleABSTRACT
Telemedicine had a significant increase during the novel coronavirus (COVID-19) pandemic, which is still on course. In different parts of the world, healthcare units had to adapt their practice, and several assistance services were remotely delivered. The present study is a systematic review of studies that had applied telemedicine during the COVID-19 pandemic and had assessed its effects on the delivered care. We have covered a 1-year period in order to assess the initiatives developed during the pandemic time and that had already evaluated the effects of the telemedicine program that had been implemented. All the analyzed studies evidenced a positive effect of telemedicine in the treatment of different conditions, including chronic diseases, mental disorders and oncologic diseases. The real impact of the COVID-19 pandemic in the healthcare sector is still to be fully understood, and telemedicine implementation in different areas is one of its positive legacies.
Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2ABSTRACT
El objetivo de este estudio es presentar una estrategia para la práctica de la enseñanza y la evaluación de la semiología cardiopulmonar a través de un examen objetivo clínico estructurado. Las clases prácticas se llevaron a cabo con estudiantes de Medicina. Los estudiantes realizaron anamnesis y examen físico de los pacientes, y posteriormente fue discutido el significado de cada signo y síntoma encontrado. Al final de las clases prácticas se realizó una evaluación práctica basada en el examen objetivo clínico estructurado. Se estableció una situación clínica en la que el estudiante tuvo que realizar la anamnesis, examen físico cardiopulmonar y describir los resultados. Se mostró, por medio de programas de ordenador, sonidos cardiopulmonares de ciertas enfermedades para que el estudiante las identificara. Fue realizada una evaluación de la actividad, a través de un cuestionario aplicado a cada estudiante. La puntuación media de la evaluación práctica fue 8,93. La evaluación de la actividad por los alumnos fue muy positiva, con puntuaciones que van de 3 a 5 en una escala de 0 a 5. La calidad de las clases y las historias clínicas también han sido bien evaluadas, con un promedio de 4. La aplicación de un examen objetivo clínico estructurado en la semiología ha demostrado ser una herramienta útil y eficaz en la evaluación del estudiante de Medicina, junto con las clases prácticas, que hicieron a los estudiantes aptos para reconocer los signos y síntomas principales de enfermedades cardiopulmonares(AU)
The aim of this study is to present a strategy for the teaching practice and evaluation of cardiopulmonary semiology through an objective structured clinical examination. Practical lessons were developed with medical students. The students did anamnesis and physical exams to patients and later, each sign and symptom that was found was analyzed. At the end of practical lessons, a practical evaluation based on the objective structured clinical examination was applied. We have established a clinical situation in which the student had to do anamnesis, physical and cardiopulmonary exam and describe the results. Using computing software, cardiopulmonary sounds present in some diseases were shown to ask the students to identify them. An evaluation of the activity was done by means of a questionnaire applied to each student. Average mark in practical evaluation was 8, 93. The students' evaluation of the activity was very positive, with marks ranging from 3 to 5 in a scale from 0 to 5. Qualities of lessons and clinical histories have also been evaluated with an average mark of 4. The implementation of an objective structured clinical examination in Semiology has proved to be an efficient and useful tool in the evaluation of the medical student together with the practical lessons that made the students apt to recognize main signs and symptoms in cardiopulmonary diseases(AU)