Predicting treatment failure, death and drug resistance using a computed risk score among newly diagnosed TB patients in Tamaulipas, Mexico.

The purpose of this study was to develop a method for identifying newly diagnosed tuberculosis (TB) patients at risk for TB adverse events in Tamaulipas, Mexico. Surveillance data between 2006 and 2013 (8431 subjects) was used to develop risk scores based on predictive modelling. The final models revealed that TB patients failing their treatment regimen were more likely to have at most a primary school education, multi-drug resistance (MDR)-TB, and few to moderate bacilli on acid-fast bacilli smear. TB patients who died were more likely to be older males with MDR-TB, HIV, malnutrition, and reporting excessive alcohol use. Modified risk scores were developed with strong predictability for treatment failure and death (c-statistic 0·65 and 0·70, respectively), and moderate predictability for drug resistance (c-statistic 0·57). Among TB patients with diabetes, risk scores showed moderate predictability for death (c-statistic 0·68). Our findings suggest that in the clinical setting, the use of our risk scores for TB treatment failure or death will help identify these individuals for tailored management to prevent these adverse events. In contrast, the available variables in the TB surveillance dataset are not robust predictors of drug resistance, indicating the need for prompt testing at time of diagnosis.

[New challenges for humanism in medical practice]. / Nuevos frentes del humanismo en la práctica médica.

This work is a review of the philosophical analysis surrounding the concept of "humanism" and what it means to be a human being, in relationship to daily life, education and medicine. The authors establish a direct relationship between humanism and bioethics as they relate to the new trends acquired through the development of institutional medicine and the increasing application of technological innovations in the health field. Both of these conditions tend to depersonalize the practice of medicine, and transform an ill person into a clinical file. Reflections are made about current topics, such as the knowledge and manipulation of human genome, assisted reproduction, abortion, survival of premature infants, organ transplants, technological innovation, euthanasia and disthanasia. Concepts and ideas are reviewed in relation to medical institutions and the sick, the physician and the community, and the physician and the government.