Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pacientes Internados , Exame Físico , Sacroileíte/diagnóstico , Sacroileíte/tratamento farmacológico , Bartonella henselae , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Doença da Arranhadura de Gato , Doenças Transmissíveis , Reabsorção Óssea , Esplenomegalia , Combinação Piperacilina e Tazobactam , VancomicinaRESUMO
No disponible
Assuntos
Humanos , Educação Médica/métodos , Modelos Educacionais , Aprendizagem , Aprendizagem Baseada em Problemas , Estudantes de Ciências da Saúde , Pandemias , Infecções por CoronavirusAssuntos
Pandemias , Estudantes de Enfermagem , Currículo , Avaliação Educacional , Humanos , AprendizagemRESUMO
Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.
Assuntos
Humanos , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Mortalidade Hospitalar , Serviço Hospitalar de Emergência , Sinais Vitais , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Tomada de Decisão Clínica , Fatores de Tempo , Cuidados Críticos , Diagnóstico Precoce , Hospitais UniversitáriosRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Aspergilose/complicações , Aspergilose/tratamento farmacológico , Transplante de Fígado , Voriconazol/uso terapêutico , Nefrectomia/métodos , Sirolimo/uso terapêutico , Fatores de Risco , Aspergillus fumigatus , Aspergillus fumigatus/isolamento & purificação , Falência Hepática/complicações , Dor Lombar/etiologia , Terapia de ImunossupressãoAssuntos
Abscesso/etiologia , Aspergilose/etiologia , Aspergillus fumigatus/isolamento & purificação , Transplante de Fígado , Nefrite/etiologia , Infecções Oportunistas/etiologia , Complicações Pós-Operatórias/etiologia , Abscesso/microbiologia , Abscesso/cirurgia , Adulto , Aspergilose/cirurgia , Hepatite Autoimune/cirurgia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Nefrectomia , Nefrite/microbiologia , Nefrite/cirurgia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/cirurgia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
BACKGROUND: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. AIM: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. PATIENTS AND METHODS: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. RESULTS: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. CONCLUSIONS: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.
Assuntos
Tomada de Decisão Clínica , Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Sinais Vitais , Cuidados Críticos , Diagnóstico Precoce , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.
Assuntos
Ectima/microbiologia , Ectima/patologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/patologia , Idoso , Biópsia , Ectima/tratamento farmacológico , Epiderme/microbiologia , Epiderme/patologia , Feminino , Gangrena , Humanos , Imunocompetência , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/fisiopatologia , Infecções Meningocócicas/classificação , Infecções Meningocócicas/complicações , Infecções Meningocócicas/tratamento farmacológico , Neisseria meningitidis Sorogrupo W-135 , Neisseria meningitidis Sorogrupo W-135/isolamento & purificação , Ceftriaxona/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Hemartrose/complicações , Hemartrose/tratamento farmacológicoRESUMO
Urticaria pigmentosa, also known as maculopapular mastocytosis, is the most common type of paediatric mastocytosis. It presents with yellow to brown macules or papules, usually located on trunk and extremities. Regarding its diagnostic and therapeutic implications, the objective of this article is to serve as an update for the paediatrician on the most relevant aspects of this pathology.
La urticaria pigmentosa, también conocida como mastocitosis maculopapular, es el tipo de mastocitosis más común en la edad pediátrica. Se presenta con máculas o pápulas de color amarillo-marrón, usualmente localizadas en el tronco y las extremidades. Considerando sus implicancias diagnósticas y terapéuticas, el objetivo de este artículo es brindar al pediatra una actualización de los aspectos más relevantes de esta patología.
Assuntos
Urticaria Pigmentosa/diagnóstico , Urticaria Pigmentosa/terapia , Criança , Humanos , PediatriaRESUMO
El ectima gangrenoso es una vasculitis necrosante poco frecuente, en la mayoría de los casos secundaria a sepsis por Pseudomonas aeruginosa en pacientes inmunocomprometidos. Sin embargo, existen reportes de ectima gangrenoso secundarios a otras etiologías infecciosas. Presentamos un caso de ectima gangrenoso asociado a una infección por Staphylococcus aureus resistente a meticilina en una paciente sin los factores de riesgo clásicos de inmunosupresión que se describen en la literatura médica.
Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.
Assuntos
Humanos , Feminino , Idoso , Infecções Estafilocócicas/patologia , Ectima/microbiologia , Ectima/patologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Biópsia , Fatores de Risco , Ectima/tratamento farmacológico , Epiderme/microbiologia , Epiderme/patologia , Gangrena , ImunocompetênciaRESUMO
BACKGROUND: The first part of the medical interview is perhaps one of the most significant components of the doctoras role. How to collect relevant information and how to build a therapeutic relationship with the patient must be taught during the undergraduate curriculum. Clinical teachers have little experience in the teaching skills required to help students learn about doctor-patient communication. AIM: To measure outcomes and perceptions of using a co-teaching model in a course on interviewing during the third year of medical school in the Pontificia Universidad Católica de Chile. MATERIAL AND METHODS: A mixed methods controlled study in which the intervention group participated in a co-teaching workshop with a clinical teacher and a specialist in doctor-patient communication skills (SDPC). The control group participated in a workshop with one clinical teacher. All students completed a questionnaire measuring perception of their learning in communication skills. Semi-structured interviews were used to collect the clinical teachers' perception. At the end of the course, the clinical and communication skills of all the students were measured in an objective structured clinical examination. RESULTS: Students and teachers agreed that co-teaching allows greater emphasis and practice in communication skills. The results of the objective structured clinical examination show that despite this greater emphasis, no deleterious effect on the clinical skills was demonstrated during the exam. CONCLUSIONS: The use of co-teaching in a course on interviewing allows students to perceive a higher level of learning in communication skills, and possibly enhances their skills. The clinical teachers felt that the co-teacher was an important support.
Assuntos
Comunicação , Educação de Graduação em Medicina , Anamnese/métodos , Relações Médico-Paciente , Ensino/métodos , Chile , HumanosRESUMO
Background: The first part of the medical interview is perhaps one of the most significant components of the doctoras role. How to collect relevant information and how to build a therapeutic relationship with the patient must be taught during the undergraduate curriculum. Clinical teachers have little experience in the teaching skills required to help students learn about doctor-patient communication. Aim: To measure outcomes and perceptions of using a co-teaching model in a course on interviewing during the third year of medical school in the Pontificia Universidad Católica de Chile. Material and Methods: A mixed methods controlled study in which the intervention group participated in a co-teaching workshop with a clinical teacher and a specialist in doctor-patient communication skills (SDPC). The control group participated in a workshop with one clinical teacher. All students completed a questionnaire measuring perception of their learning in communication skills. Semi-structured interviews were used to collect the clinical teachers' perception. At the end of the course, the clinical and communication skills of all the students were measured in an objective structured clinical examination. Results: Students and teachers agreed that co-teaching allows greater emphasis and practice in communication skills. The results of the objective structured clinical examination show that despite this greater emphasis, no deleterious effect on the clinical skills was demonstrated during the exam. Conclusions: The use of co-teaching in a course on interviewing allows students to perceive a higher level of learning in communication skills, and possibly enhances their skills. The clinical teachers felt that the co-teacher was an important support.