RESUMO
OBJECTIVE: Outpatient antimicrobial therapy works but often requires in-person oversight. Advancements enable seamless communication. We used instant messaging to track adherence, cost, efficacy, and adverse events for outpatient intramuscular antibiotic therapy. MATERIAL AND METHODS: We invited eligible inpatients with bacterial isolates susceptible to ceftriaxone, cefepime, ceftazidime, meropenem, or ertapenem and a positive clinical response to infection to join the study. Participants received antibiotics and submitted daily photos of the used vial through an instant messaging application. After treatment, we conducted virtual follow-ups on days 14 and 28. We asked subjects about adverse events or ongoing symptoms. Any concerns prompted a recommendation to come back for additional evaluation. We calculated the economic impact using the number of outpatient days as reduced hospitalization days, the cost of materials, and nursing personnel expenses. RESULTS: A total of 30 patients were included; 90% of the subjects showed good adherence, while five exhibited protocol deviations. We observed a 38.3% reduction in hospital costs. Treatment failure occurred in 13.7%, resulting in one readmission. We found no significant adverse events. DISCUSSION: Integrating WhatsApp enhances healthcare through a free, user-friendly model. It boosts communication, privacy, and antibiotic effectiveness, improving outcomes. Our low-cost approach aids monitoring, particularly in resource-limited settings. Some limitations include no control group, specific intramuscular criteria, and limited expertise. These findings guide future projects and IT-based care models. CONCLUSIONS: The 90% adherence rate in this study serves as a proof-of-concept for instant messaging as an adherence tool for timely deviation identification and enhancing institutional savings during outpatient antibiotic therapy.
Assuntos
Antibacterianos , Adesão à Medicação , Estudo de Prova de Conceito , Envio de Mensagens de Texto , Humanos , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Injeções Intramusculares , Idoso , Pacientes AmbulatoriaisRESUMO
The "acute undifferentiated febrile illness" (AUFI) encompasses a range of diseases characterized by the presence of fever, often prompting consultations in emergency services. During epidemics like COVID-19 or dengue, a surge in consultations occurs, resulting in long wait times for patients. Errors in first diagnosis can result in severe consequences. The objective is to provide a comprehensive review of the clinical approach to AUFI, focusing on certain viral infections (dengue, zika, Argentine hemorrhagic fever and COVID-19). This involves a detailed examination of the clinical presentation, laboratory and radiological findings, neurological manifestations, and definitive diagnosis through specific serological tests. AUFI is characterized by the onset of acute fever lasting less than seven days, accompanied by myalgia or headache without involvement of the upper respiratory tract and without a defined cause. Most cases are caused by common, self-limiting viral infections (e.g., influenza); however, they may also stem from more serious viral infections with a broad etiological spectrum. The differential diagnosis of acute febrile syndromes includes various infectious diseases, such as those previously mentioned. The definitive diagnosis is based on serological methods, PCR and IgM. Recommendations based on scientific evidence can help with early diagnosis and prevent possible serious complications.
El "síndrome febril agudo inespecífico" (SFAI) abarca una variedad de enfermedades que se distinguen por la presencia de fiebre, convirtiéndose en una causa común de consulta en los servicios de urgencias. Durante epidemias como la del COVID-19 o dengue (brote epidémico), se observa un aumento significativo de consultas con larga fila de pacientes esperando ser atendidos. Errores u omisiones en el diagnóstico inicial pueden acarrear graves consecuencias. El objetivo es ofrecer una revisión exhaustiva del enfoque clínico del SFAI, centrándose en determinadas infecciones virales (dengue, zika, fiebre hemorrágica argentina y COVID-19). Se examina detalladamente la presentación clínica, los hallazgos de laboratorio y radiológicos, las manifestaciones neurológicas y el diagnóstico definitivo mediante pruebas serológicas específicas. El SFAI se caracteriza por la aparición de fiebre aguda que dura menos de siete días, acompañada de mialgia o dolor de cabeza, sin afectación de las vías respiratorias superiores y sin una causa definida. La mayoría de los casos se deben a infecciones virales comunes, que suelen ser autolimitadas (ej. influenza); sin embargo, también pueden ser el resultado de infecciones virales más graves con un amplio espectro etiológico. El diagnóstico diferencial de los síndromes febriles agudos abarca diversas enfermedades infecciosas, como las mencionadas previamente. El diagnóstico definitivo se basa en métodos serológicos, PCR e IgM. Las recomendaciones basadas en evidencia científica pueden ayudar a un diagnóstico temprano y prevenir serias complicaciones.
Assuntos
COVID-19 , Dengue , Febre , Infecção por Zika virus , Humanos , COVID-19/diagnóstico , Diagnóstico Diferencial , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/complicações , Dengue/diagnóstico , Febre/diagnóstico , Febre/etiologia , Febre/virologia , SARS-CoV-2 , Doença Aguda , Pacientes Ambulatoriais , Febres Hemorrágicas Virais/diagnósticoRESUMO
Background: Hematopoietic cell transplantation (HCT) increases survival for acute leukemia. Outpatient allogeneic HCT reduces costs and increases transplant rates in developing countries. We report outcomes of outpatient HLA-identical and haploidentical HCT in acute leukemia. Methods: This single-center retrospective cohort study analyzed 121 adult patients with acute myeloblastic (AML) and acute lymphoblastic leukemia (ALL) receiving an outpatient allogeneic HCT with peripheral blood allografts after reduced-intensity conditioning (RIC) from 2012-2022. Results: There were 81 (67%) haploidentical and 40 (33%) HLA-identical transplants. Complete chimerism (CC) at day +100 was not different in HLA-identical compared to haploidentical HCT (32.5% and 38.2%, P=0.054). Post-HCT complications, including neutropenic fever (59.3% vs. 40%), acute graft-versus-host-disease (aGVHD) (46.9% vs. 25%), cytokine release syndrome (CRS) (18.5% vs. 2.5%), and hospitalization (71.6% vs 42.5%) were significantly more frequent in haploidentical HCT. Two-year overall survival (OS) was 60.6% vs. 46.9%, (P=0.464) for HLA-identical and haplo-HCT, respectively. There was no difference in the 2-year disease-free-survival (DFS) (33.3% vs. 35%, P=0.924) between transplant types. In multivariate analysis, positive measurable residual disease (MRD) at 30 days (HR 8.8, P=0.018) and 100 days (HR 28.5, P=0.022) was associated with lower OS, but not with non-relapse mortality (NRM) (P=0.252 and P=0.123, univariate). In univariate analysis, both 30-day and 100-day MRD were associated with lower DFS rates (P=0.026 and P=0.006), but only day 30 MRD was significant in multivariate analysis (P=0.050). In the case of relapse, only MRD at day 100 was associated with increased risk in the univariate and multivariate analyses (HR 4.48, P=0.003 and HR 4.67, P=0.008). Chronic graft-versus-host-disease (cGVHD) was protective for NRM (HR 0.38, P=0.015). There was no difference in cumulative incidence of relapse (CIR) between transplant types (P=0.126). Forty-four (36.4%) patients died, with no difference between HCT type (P=0.307). Septic shock was the most frequent cause of death with 17 cases, with no difference between transplant types. Conclusions: Outpatient peripheral blood allogenic HCT after RIC is a valid and effective alternative for adult patients suffering acute myeloblastic or lymphoblastic leukemia in low-income populations.
Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Irmãos , Condicionamento Pré-Transplante , Transplante Haploidêntico , Humanos , Condicionamento Pré-Transplante/métodos , Masculino , Feminino , Adulto , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Pessoa de Meia-Idade , Doença Enxerto-Hospedeiro/etiologia , Estudos Retrospectivos , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Transplante Haploidêntico/efeitos adversos , Adulto Jovem , Leucemia Mieloide Aguda/terapia , Leucemia Mieloide Aguda/mortalidade , Adolescente , Antígenos HLA/imunologia , Idoso , Transplante Homólogo , Pacientes Ambulatoriais , Resultado do TratamentoRESUMO
Objective: The aim of this study was to evaluate the efficacy of a self-assessment questionnaire for hirsutism using the latest cutoff values recommended by the Endocrine Society (ES) for Latin-American women and by the European Society for Human Reproduction and Embryology (ESHRE). Subject and methods: Female premenopausal outpatients (n = 188) completed a self-assessment questionnaire, scoring hair presence across the nine areas evaluated by the modified Ferriman-Gallwey (mFG) scale. The results were compared with clinician-assessed scores rated independently by two trained physicians. Scores in the Hirsuta questionnaire, derived from self-assessment of five areas of the mFG scale, were also evaluated. Results: The ethnic composition of the sample was as follows: 23.1% white, 25.8% black, 48.9% mixed, and 2.1% other backgrounds (Indigenous, Asian). The participants had age and BMI of (mean ± standard deviation) 33.7 ± 9.9 years and 29.8 ± 7.21 kg/m2, respectively. The most common areas of excessive hair growth were the chin, upper and lower abdomen, and thighs. Relative to clinician-assessed mFG scores, self-assessed mFG scores had an accuracy of 80% using ES criteria for hirsutism diagnosis, with a sensitivity of 95.45%, specificity of 56.25%, positive predictive value of 30.10%, and negative predictive value of 98.40%. Self-assessed mFG had lower accuracy (71%) for diagnosing hirsutism when the ESHRE criteria were applied. Conclusions: Self-assessed mFG had low specificity, limiting its application. The results of this study do not support the use of the self-assessed mFG or Hirsuta scores for diagnosing hirsutism in a clinical setting, although both scoring systems may be useful for screening hirsutism in epidemiological studies.
Assuntos
Hirsutismo , Humanos , Hirsutismo/diagnóstico , Feminino , Adulto , Brasil , Inquéritos e Questionários/normas , Autoavaliação (Psicologia) , Pacientes Ambulatoriais , Adulto Jovem , Reprodutibilidade dos Testes , Pessoa de Meia-Idade , Autoavaliação Diagnóstica , Adolescente , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). METHODS: This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow-up time ≥ 6 months. RESULTS: Compared to PHP patients (n = 183), UHS patients (n = 276) were older (63.4 vs. 59.7 years, p=0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, p=0.02) and dyslipidemia (58.3 vs. 38.3%, p < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5-42.0] vs. 39.1 [28.6-54.8] mL/min/1.73 m2, p < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, p=0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, p=0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, p < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; p=0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; p=0.83), dyslipidemia and LDL-cholesterol < 100 mg/dL (38.3% vs. 49.3%; p=0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16), and 25-OH-vitamin-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p < 0.01). In the multivariate linear mixed-effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, p < 0.01; time effect, p < 0.01; interaction, p < 0.01). CONCLUSIONS: Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis.
Assuntos
Pacientes Ambulatoriais , Qualidade da Assistência à Saúde , Hemoglobinas Glicadas , Estudos Longitudinais , Insuficiência Renal Crônica , Hormônio Paratireóideo , Colesterol , Diálise Renal , HipertensãoRESUMO
BACKGROUND: Heart failure (HF) can coexist with atrial fibrillation in up to 60 % of cases, increasing rates of hospitalizations and death. This study analyzed the clinical characteristics, treatment, hospitalization, and mortality of patients with HF and atrial fibrillation based on left ventricular ejection fraction (LVEF). METHODS: A retrospective cohort study included patients from an outpatient HF clinic at Medellín (Colombia) between 2020-2022. Patients were classified into two groups according to LVEF: reduced (LVEF≤40 %) and mildly reduced or preserved ejection fraction (LVEF>40 %). The evaluated outcomes were hospitalization and mortality during follow-up. Values for B-type natriuretic peptide (BNP), LVEF and functional class according to the New York Heart Association (NYHA) were also analyzed at admission and during the last follow-up visit. RESULTS: The study included 185 patients, with 51.9% being male. The median age of the participants was 80 years (interquartile range [IQR] 74 - 86). There was an overall improvement in the NYHA functional class, BNP levels, and LVEF compared with the baseline values, irrespective of left systolic function. Atrial fibrillation ablation was performed in 3.2 % of patients, and cardiac device implantation with atrioventricular node ablation in 29 %. No statistically significant differences were found in terms of hospitalization and mortality regarding left systolic function. CONCLUSION: Compressive optimal treatment for patients with HF and atrial fibrillation requires pharmacological treatment, ablation strategies, cardiac devices, cardiovascular rehabilitation and close follow-up. In this cohort, hospitalization and mortality rates were similar according to LVEF categories and there was improvement in NYHA functional class and BNP level.
Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Volume Sistólico , Humanos , Fibrilação Atrial/terapia , Fibrilação Atrial/epidemiologia , Masculino , Feminino , Colômbia/epidemiologia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Idoso , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Hospitalização/estatística & dados numéricos , Resultado do Tratamento , Seguimentos , Instituições de Assistência Ambulatorial , Pacientes Ambulatoriais/estatística & dados numéricosRESUMO
This study aims to investigate both the prevalence and associated factors of frailty, pre-frailty, and each criterion of frailty according to the Fried phenotype criteria among older adult outpatients receiving care from geriatric services. A cross-sectional study was conducted between 2020 and 2022 and included 335 older adults. Fried's criteria and a comprehensive geriatric assessment, including physical, clinical and mental health variables were investigated. More than half of participants presented frailty (11.6 %) and/or pre-frailty (43.3 %) according to Fried's criteria, with physical inactivity and low gait speed as the most prevalent criteria. Several factors demonstrated associations with the diagnosis of frailty/pre-frailty, including retirement status, marital status (unmarried), the use of walking aids, lower educational attainment, decreased functional status, and poor mental health. Furthermore, various factors were associated with each of Fried's criteria, highlighting that certain factors might align with a specific criterion without necessarily correlating with the diagnosis of frailty and pre-frailty.
Assuntos
Idoso Fragilizado , Fragilidade , Avaliação Geriátrica , Pacientes Ambulatoriais , Humanos , Masculino , Estudos Transversais , Feminino , Idoso , Prevalência , Idoso de 80 Anos ou maisRESUMO
A long-term indwelling catheter may be indicated in clinical situations, such as chronic diseases of the genitourinary or neurological systems. In addition to the risks of infection, trauma, and bleeding, a catheter's permanence can affect psycho-emotional and socioeconomic dimensions. We aimed to understand how the need to use a long-term indwelling catheter affects this patient's self-perception, interrelationships, and self-care. We carried out a qualitative, descriptive study based on interviews with 17 patients, and applied thematic analysis and complex thinking. The different prognoses and expectations regarding the catheter influenced self-perception, adaptation, acceptance, or denial. The presence of a catheter, whether as a curative measure or for comfort, can affect self-image and sexuality, and generate insecurities and uncertainties, which require understanding the multidimensionality of situations that suffer interference from the personal, family, and social environment, as well as health systems' capacity to deal with it. Despite the challenges, the majority of participants reported a favorable disposition towards self-care, whether to enable catheter removal or to prevent injuries in lifelong indications.
O cateter vesical de longa permanência pode ser indicado em situações clínicas, como nas doenças crônicas do sistema genitourinário ou neurológico. Além dos riscos de infecção, traumas e sangramentos, a permanência do cateter pode afetar dimensões psicoemocionais e socioeconômicas. Objetivamos compreender como a necessidade de uso do cateter urinário por um longo prazo afeta a autopercepção, as interrelações e o autocuidado deste paciente. Realizamos um estudo qualitativo, descritivo, a partir da entrevista de 17 pacientes, e aplicamos a análise temática e o pensamento complexo. Os diferentes prognósticos e as expectativas em relação ao cateter influenciaram a autopercepção, a adaptação, sua aceitação ou negação. A presença do cateter, seja como medida curativa ou para conforto, pode afetar a autoimagem e a sexualidade, gerar inseguranças e incertezas, que requerem compreensão da multidimensionalidade das situações, que sofrem interferências do meio pessoal, familiar e social, bem como da capacidade dos sistemas de saúde para o seu enfrentamento. Apesar dos desafios, a maioria dos participantes relatou disposição favorável para o autocuidado, seja para viabilizar retirada do cateter, ou para prevenir agravos em indicações vitalícias.
Assuntos
Cateteres de Demora , Autocuidado , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cateteres de Demora/efeitos adversos , Adulto , Fatores de Tempo , Idoso , Entrevistas como Assunto , Autoimagem , Assistência Ambulatorial , Pesquisa Qualitativa , Pacientes Ambulatoriais/psicologia , Adulto JovemRESUMO
OBJECTIVE: To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil. METHODS: This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge. RESULTS: Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038). CONCLUSION: COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves.ClinicalTrials.gov Identifier: NCT04479488.
Assuntos
COVID-19 , Hospitalização , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Ambulatorial/estatística & dados numéricos , Brasil/epidemiologia , Estudos de Coortes , COVID-19/mortalidade , COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
Up to 80% of children admitted to a hospital experience pain, mainly associated with venipuncture. OBJECTIVE: To analyze whether the use of virtual reality (VR) headsets during venipuncture can modify the perception of pain, anxiety, and fear in pediatrics. PATIENTS AND METHOD: Open label, randomized clinical trial. The presence of intellectual, visual, or hearing impairment were considered exclusion criteria. Two anxiety and fear scales were administered before and after the procedure, and the Wong-Baker face pain scale at the end. The following were recorded: number of venipuncture attempts, duration of the procedure, and side effects. RESULTS: 78 patients were included, 38 males and a mean age of 9.63 years. In the intervention group, the mean pain value was 2.87, with a mean difference (MD) of -0.85 compared with the control one (95% confidence interval (CI) -2.02 to 0.33). There was a significant reduction in the level of anxiety and fear, with MDs of -2.59 (95%CI: -3.92 to -1.26) and -0.85 points (95%CI: -1.45 to -0.24), respectively. CONCLUSIONS: the use of VR headsets in venipuncture in hospital daytime care decreases the level of anxiety and fear in children and seems to reduce pain, without adverse effects. The venipuncture procedure has the same success rate and does not increase its duration.
Assuntos
Ansiedade , Medo , Medição da Dor , Flebotomia , Realidade Virtual , Humanos , Masculino , Medo/psicologia , Flebotomia/efeitos adversos , Flebotomia/psicologia , Feminino , Ansiedade/prevenção & controle , Criança , Adolescente , Dor Processual/prevenção & controle , Dor Processual/etiologia , Dor/prevenção & controle , Dor/psicologia , Pacientes Ambulatoriais , Terapia de Exposição à Realidade Virtual/métodos , Pré-EscolarRESUMO
BACKGROUND: Depression represents one of the leading causes of disability due to illness worldwide. Previous studies have demonstrated the significant heterogeneity of the diagnosis of depression, making it necessary to develop new diagnostic approaches. Network analysis is a perspective that considers symptoms as constituents of the psychiatric disorder itself. The objective was to determine the structure of depressive symptoms using the CES-D and ZDS depression scales. METHODS: Cross-sectional study of secondary analysis of 194 patients using the CES-D and ZDS scales. Correlation matrices and regularised partial correlation networks were constructed from the database. Centrality measures were estimated, and a network stability analysis was performed. RESULTS: On the CES-D scale, the most central item was "Sad"; while on the ZDS scale, the most central items were "Sad" and "Live". On the CES-D scale, the connection between "Enjoy" and "Happy" was the strongest. On the ZDS scale, the strongest connection was between the items "Live" with "Useful". The item "Morning" was the least connected on the ZDS. CONCLUSIONS: The most central symptom from the CES-D scale was sadness, while from the ZDS scale, was sadness and anhedonia.
Assuntos
Depressão , Hospitais Gerais , Pacientes Ambulatoriais , Escalas de Graduação Psiquiátrica , Humanos , Peru , Estudos Transversais , Masculino , Feminino , Depressão/epidemiologia , Depressão/diagnóstico , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Idoso , Adolescente , AnedoniaRESUMO
BACKGROUND: It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. OBJECTIVE: Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. MATERIAL AND METHODS: Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. RESULTS: Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. CONCLUSIONS: The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.
ANTECEDENTES: Los antiinflamatorios y los antirreumáticos no esteroideos (AINE) disminuyen la eficacia de algunos antihipertensivos. OBJETIVO: Analizar el patrón de prescripción de AINE y las variables asociadas en pacientes ambulatorios con diagnóstico de hipertensión arterial, así como explorar algunas características de los médicos prescriptores. MATERIAL Y MÉTODOS: Estudio transversal de pacientes con hipertensión de la Unidad de Medicina Familiar 24 en Ciudad Mante, Tamaulipas. De los pacientes se registraron datos sociodemográficos, antecedentes patológicos y tratamientos farmacológicos; y de los médicos, información sociodemográfica y académica. RESULTADOS: La edad promedio de los pacientes fue de 63 ± 11 años, 31.7 % recibía AINE y al contrastarlos con quienes no los recibían, se identificó mayor proporción de obesidad, presión arterial más elevada, más casos en descontrol de la hipertensión arterial, multimorbilidad y polimedicación. Las variables asociadas a la prescripción de AINE fueron estar en descontrol de la hipertensión arterial, multimorbilidad y polimedicación; 56.7 % de los médicos prescriptores fue del sexo femenino, 83.3 % con antigüedad superior a 10 años y 33.3 % con certificación vigente. CONCLUSIONES: La prescripción inapropiada de AINE reveló la necesidad de implementar acciones para mitigar el riesgo potencial de los pacientes hipertensos de presentar una complicación.
Assuntos
Anti-Inflamatórios não Esteroides , Antirreumáticos , Hipertensão , Pacientes Ambulatoriais , Polimedicação , Humanos , Feminino , Estudos Transversais , Masculino , Pessoa de Meia-Idade , Anti-Inflamatórios não Esteroides/uso terapêutico , Hipertensão/tratamento farmacológico , Idoso , Antirreumáticos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Prescrição Inadequada/prevenção & controleRESUMO
OBJECTIVE: Antibiotic resistance is increasing globally, associated with many failures in pneumonia treatment. This study aimed to evaluate antibiotic use in children treated for outpatient CAP (Community-Acquired Pneumonia). METHODS: A cross-sectional descriptive retrospective study was conducted, focusing on data from outpatient prescriptions for pneumonia in patients aged 2â192 months in 2019â2021. RESULTS: All antibiotic prescriptions are considered empiric as no documented bacterial and viral tests exist for children with non-severe CAP. Single antibiotic therapy (66%) had a 2-fold higher rate than combination therapy (34%). Amoxicillin/clavulanic acid (50.77%) and azithromycin (30.74%) were the most commonly prescribed in both single and combination therapies, thus determining antibiotic cost (80.15%). Besides, azithromycin (97.92%), cefuroxime (86.26%), and cefpodoxime (60.48%) were prescribed with high adherence to dose guidelines, except for amoxicillin (34.57%). These medicines are prescribed highly compliant (>83%) with dosing interval guidelines. Furthermore, significantly more brand-name antibiotics (56.5%) are prescribed than generic antibiotics (43.5%). In particular, antibiotic class, antibiotic origin, and antibiotic therapies showed significant association with rational antibiotic prescriptions for dose and dose interval (p < 0.05). CONCLUSIONS: Amoxicillin/clavulanic acid is the most frequently prescribed medicine and the most inappropriate due to non-compliance with dose guidelines for CAP treatment. Generic antibiotic use for single therapy should be encouraged based on rapid and accurate diagnostic testing for viruses and bacteria to reduce antibiotic resistance in developing countries. Moreover, the study result has also shown that therapies and antibiotics (class and origin) exhibited significant association with rational prescriptions for CAP treatment for pediatrics.
Assuntos
Antibacterianos , Infecções Comunitárias Adquiridas , Humanos , Antibacterianos/uso terapêutico , Estudos Transversais , Estudos Retrospectivos , Pré-Escolar , Criança , Lactente , Feminino , Masculino , Vietnã , Infecções Comunitárias Adquiridas/tratamento farmacológico , Adolescente , Pacientes Ambulatoriais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Assistência Ambulatorial/estatística & dados numéricosRESUMO
Although commonly used in clinical practice, scientific literature about clozapine prescription patterns in Colombia is scarce. A cross-sectional observational study was conducted in an outpatient clinic in Bogotá, Colombia. Between 2016 and 2018, clozapine was prescribed to 2603 patients, mainly for Schizophrenia Spectrum Disorders and Bipolar and Depressive Disorders, at a median dose of 100mg/day. After controlling for other variables, older age was the only variable that explained the use of doses lower than 100mg/day. Clozapine was not only used for Treatment-Resistant Schizophrenia, and further studies are needed to explain these differences.
Aunque se utiliza comúnmente en la práctica clínica, la literatura científica sobre los patrones de prescripción de clozapina en Colombia es escasa. Se realizó un estudio observacional transversal en el servicio ambulatorio de una clínica de referencia en Bogotá, Colombia. Entre 2016 y 2018, se recetó clozapina a 2603 pacientes, principalmente para esquizofrenia y trastornos relacionados, trastorno afectivo bipolar y trastornos depresivos, a una dosis media de 100 mg/día. Después de controlar otras variables, la edad avanzada fue la única variable que explicó el uso de dosis inferiores a 100 mg/día. La clozapina no se utilizó sólo para la esquizofrenia resistente al tratamiento, y se necesitan estudios adicionales para explicar estas diferencias.
Assuntos
Antipsicóticos , Clozapina , Humanos , Clozapina/administração & dosagem , Clozapina/uso terapêutico , Colômbia , Estudos Transversais , Masculino , Feminino , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Adulto , Pessoa de Meia-Idade , Assistência Ambulatorial , Prescrições de Medicamentos/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Pacientes Ambulatoriais , Adulto JovemRESUMO
OBJECTIVE: Due the lack of data on the treatment of Vascular Vertigo and Dizziness, this study aimed to report how we managed and treated those outpatients according to the recently introduced American Heart Association and Stroke Association guidelines. METHODS: We conducted a longitudinal case series from May 2022 to February 2023. We included patients who met the Bárány Society's Vascular Vertigo and Dizziness classification and were eligible for therapy in accordance with the American Heart Association and Stroke Association guidelines, featuring aspects of the stroke group and transient attack group. RESULTS: Overall, 41 patients (51.2% female; median age 72 years) were enrolled; 10 (24.3%) had ischemic strokes, 30 (73.1%) had transient ischemic attack, and 1 (2.4%) had a probable isolated labyrinthine infarction. The patients received dual antiplatelet (48.7%), single antiplatelet therapy (48.7%), and anticoagulant therapy (2.4%). No new crises occurred in 95.2% of the patients, and the transient ischemic attack group showed a significant decrease in discomfort from imbalance on the visual analog scale. CONCLUSIONS: Antiplatelets and anticoagulants are safe and effective in treating Vascular Vertigo and Dizziness as they prevent new ischemic events and increase the flow of the posterior circulation, reducing vertigo/dizziness attacks and imbalance complaints.
Assuntos
Anticoagulantes , Tontura , Inibidores da Agregação Plaquetária , Vertigem , Humanos , Tontura/etiologia , Feminino , Masculino , Idoso , Vertigem/etiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Pessoa de Meia-Idade , Anticoagulantes/uso terapêutico , Pacientes Ambulatoriais , Idoso de 80 Anos ou mais , Estudos Longitudinais , Ataque Isquêmico Transitório/complicações , AVC Isquêmico/complicações , AVC Isquêmico/tratamento farmacológicoRESUMO
BACKGROUND: Although standard operational procedures for pre-therapeutic dosimetry already exist for the determination of the maximum safe activity to treat differentiated thyroid cancer patients, empiric activity administration of 131I is still the most frequent way of treatment. In this way, the absorbed dose to the blood/bone marrow remains unknown. PURPOSE: In this work, we present a strategy to estimate radiation dose to the blood in an outpatient setting. METHODS: A mobile application was developed, which together with an off-the-shelf compact semiconductor radiation detector allows the determination of whole-body time-integrated activity coefficients. The methodology was tested in a cohort of 79 differentiated cancer patients who received therapeutic 131I activities. Post-therapeutic whole-body time-integrated activity coefficients were compared against pre-therapeutic estimates in a subset of 13 patients. RESULTS: The 95% limits of agreement between pre whole-body and post whole-body time integrated activity coefficients were [-14.4; 6.6] h when considering outliers and [-6.2; 3.6] h without outliers. A high dispersion in blood dose coefficients was found, with a four-fold difference between the highest and lower values. Blood doses were significantly higher for patients treated with dosimetrically guided activities than for empirical activities (median dose = 118 vs. 49 cGy, respectively). Blood dose coefficients were significantly lower for patients prepared with recombinant human thyroid stimulating hormone (rhTSH) than for patients prepared with thyroid hormone withdrawal. A low correlation between blood dose and administered activity was found in empirically treated patients (R2 = 0.26). CONCLUSIONS: We successfully implemented a post-therapeutic internal dosimetry methodology for differentiated thyroid cancer therapy with 131I, which allows to estimate dose to the blood from outpatient measurements with mobile devices. The proposed methodology avoids the need of daily visits to the nuclear medicine department, thus reducing the burden for the patient and for the staff.
Assuntos
Radioisótopos do Iodo , Pacientes Ambulatoriais , Neoplasias da Glândula Tireoide , Humanos , Radioisótopos do Iodo/uso terapêutico , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/sangue , Doses de Radiação , Masculino , Radiometria , Feminino , Pessoa de Meia-Idade , Adulto , Aplicativos Móveis , Dosagem Radioterapêutica , IdosoRESUMO
OBJECTIVE: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia. STUDY DESIGN: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020). RESULTS: Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P < .001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9 days, SD 0.5 days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P < .001). CONCLUSIONS: A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.
Assuntos
Antibacterianos , Infecções Comunitárias Adquiridas , Pneumonia , Padrões de Prática Médica , Humanos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Lactente , Adolescente , Feminino , Masculino , Pneumonia/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Assistência Ambulatorial , Registros Eletrônicos de Saúde , Análise de Séries Temporais Interrompida , Gestão de Antimicrobianos/métodos , Pacientes Ambulatoriais , Melhoria de QualidadeRESUMO
Idiopathic inflammatory myopathies, especially antisynthetase syndrome, often appear outside of the muscles as interstitial lung disease (ILD). Another typical finding is the presence of mechanic's hands. The aim of the present study was to describe the clinical, functional, tomographic, and serological data of patients with ILD and mechanic's hands and their response to treatment and survival rates. This is a retrospective study of ILD with concurrent myopathy. Among the 119 patients initially selected, 51 had mechanic's hands. All the patients were screened for anti-Jo-1 antibodies. An expanded panel of myopathy autoantibodies was also performed in 27 individuals. Of the 51 patients, 35 had 1 or more antibodies. The most common were anti-Jo-1, anti-PL-7, and anti-PL-12, while of the associated antibodies, anti-Ro52 was present in 70% of the 27 tested individuals. A significant response to treatment was characterized by an increase in predicted forced vital capacity (FVC) of at least 5% in the last evaluation done after 6 to 24 months of treatment. A decrease in predicted FVC of at least 5%, the need for oxygen therapy, or death were all considered treatment failures. All patients were treated with corticosteroids, and 71% with mycophenolate. After 24 months, 18 patients had an increase in FVC, 11 had a decrease, and 22 remained stable. After a median follow-up of 58 months, 48 patients remained alive and three died. Patients with honeycombing on high-resolution chest tomography (log-rankâ =â 34.65; Pâ <â .001) and a decrease in FVCâ ≥5% (log-rankâ =â 18.28, Pâ <â .001) had a poorer survival rate. Patients with ILD and mechanic's hands respond well to immunosuppressive treatment.
Assuntos
Doenças Pulmonares Intersticiais , Miosite , Humanos , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/terapia , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/fisiopatologia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Miosite/terapia , Miosite/mortalidade , Miosite/tratamento farmacológico , Miosite/complicações , Idoso , Resultado do Tratamento , Adulto , Autoanticorpos/sangue , Pacientes Ambulatoriais/estatística & dados numéricos , Corticosteroides/uso terapêutico , Capacidade VitalRESUMO
Antimicrobial resistance (AMR) in the community is increasing worldwide. We aimed to assess AMR trends in Escherichia coli from the community urine isolates in French Amazonia. We conducted a retrospective study from January 2016 to December 2022 in the Cayenne General Hospital microbiology laboratory (French Guiana). It included all urine samples positive for E. coli collected from adult outpatients. During the study period, 3,443 urinalyses positive for E. coli were studied. In 46% of cases, patients were women. In 64.4% of cases, E. coli were ß-lactamase producers. The most frequently diagnosed resistance mechanisms were penicillinase production and sparing third-generation cephalosporins. Isolated E. coli were extended-spectrum ß-lactamase (ESBL) producers in 6.1% of cases. Overall, E. coli was susceptible to amoxicillin in 35.9% [95% CI: 34.3-37.5], to amoxicillin/clavulanic acid in 62.2% [95% CI: 60.6-63.9], to cefotaxime in 94% [95% CI: 93.1-94.7], to gentamicin in 92.1% [95% CI: 89.1-92.6], to ofloxacin in 76.8% [95% CI: 75.3-78.2], to trimethoprim/sulfamethoxazole (SXT) in 58.8% [95% CI: 57.1-60.5], to fosfomycin in 99.1% [95% CI: 98.6-99.4], and to nitrofurantoin in 99% of cases [95% CI: 98.6-99.3]. We have observed a gradual decline in the susceptibility profile of E. coli for amoxicillin/clavulanic acid (P <0.001), piperacillin/tazobactam (P = 0.003), and temocillin (P = 0.006). However, susceptibility to ciprofloxacin was increasing (P = 0.001). In contrast, the susceptibility trends for amoxicillin, third-generation cephalosporins, gentamicin, SXT, nitrofurantoin, and fosfomycin remained stable over the 28 quarters of the study. In conclusion, isolated E. coli from outpatient urinalyses showed increased resistance profiles involving penicillinase and ESBL production. Close monitoring and strategies to decrease antibiotic consumption in the community are needed.
Assuntos
Antibacterianos , Infecções por Escherichia coli , Escherichia coli , Testes de Sensibilidade Microbiana , Pacientes Ambulatoriais , Humanos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/urina , Masculino , Estudos Retrospectivos , Guiana Francesa/epidemiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Pacientes Ambulatoriais/estatística & dados numéricos , Adulto , Pessoa de Meia-Idade , Prevalência , Infecções Urinárias/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , beta-Lactamases/genética , Farmacorresistência Bacteriana , Idoso , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Adulto JovemRESUMO
Introducción. El examen genital en varones es una evaluación clínica simple y rápida para detectar patología urogenital. Los datos sobre prevalencia de patología urogenital en varones adolescentes son limitados. Nuestro objetivo fue describir la prevalencia de patología urogenital en varones adolescentes. Población y métodos. Estudio descriptivo transversal en el Servicio de Adolescencia de un hospital público de la Ciudad de Buenos Aires. Se evaluaron retrospectivamente las historias clínicas (HC) de varones de 9 a 20 años atendidos entre 2008 y 2018; se incluyeron las que tenían examen genital. Se recabaron datos de edad, estadio puberal, orquidometría, patología urogenital antes de la adolescencia y al momento de la consulta. La prevalencia se expresó en porcentaje e intervalo de confianza del 95 % (IC95%). Se estimó necesario incluir 1167 HC como muestra poblacional. Resultados. Se evaluaron 2129 HC; se incluyeron 1429. En 686 casos no se hizo el examen genital. La población tuvo una mediana de edad de 12 años (rango intercuartílico 11-14 años). En 72 varones (5,7 %; IC95% 4,5-7,2), se halló una enfermedad genitourinaria antes de la adolescencia. Se detectó al menos una patología urogenital en 272 adolescentes (14,8 %; IC95% 13,1-16,7); las más frecuentes fueron adherencia balanoprepucial 5,3 % (IC95% 4,2-6,6), varicocele 2,7 % (IC95% 2-3,7) y fimosis 1,8 % (IC95% 1,2-2,6). Conclusiones. El examen genital permitió detectar que el 14,8 % de los varones adolescentes atendidos presentó alguna patología urogenital. Las entidades más frecuentes fueron adherencia balanoprepucial, varicocele y fimosis.
Introduction. The male genital exam is a simple and quick assessment to look for urogenital disease. Data on the prevalence of urogenital disease in male adolescents are limited. Our objective was to describe the prevalence of urogenital disease in male adolescents. Population and methods. Descriptive, cross-sectional study conducted at the Department of Adolescenceof a public hospital in the City of Buenos Aires. The medical records of male patients aged 9 to 20 years seen between 2008 and 2018 were retrospectively reviewed; all those with a genital exam were included. Data on age, pubertal stage, orchidometry, and urogenital disease before adolescence and at the time of consultation were recorded. The prevalence was described as percentage and 95% confidence interval (CI).As per estimations, 1167 medical records had to be included to establish the population sample. Results. A total of 2129 medical records were assessed and 1429 were included. No genital exam had been conducted in 686 cases. The median age of the population was 12 years (interquartile range: 1114 years). Urogenital disease before adolescence was detected in 72 boys (5.7%; 95% CI: 4.57.2). Urogenital disease was found in 272 adolescents (14.8%; 95% CI: 13.116.7); the most common conditions were balanopreputial adhesions in 5.3% (95% CI: 4.26.6), varicocele in 2.7% (95% CI: 23.7), and phimosis in 1.8% (95% CI: 1.22.6). Conclusions. A genital exam allowed to detect that 14.8% of adolescent boys had a urogenital diseaseThe most common conditions were balanopreputial adhesions, varicocele, and phimosis.