Medicina clinica
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The current SARS-CoV-2 pandemic poses numerous health challenges, including the adequate use and proper interpretation of the different available tests in different clinical settings. As any diagnostic test, those of SARS-CoV-2 have methodological limitations of sensitivity (S) and specificity (E), which eventually determine their positive (PPV) and negative (NPV) predictive value. Furthermore, their diagnostic performance depends on the clinical context in which these tests are used, that is, on the pretest probability. This article: (1) reviews the main methodological aspects that influence the S, E, PPV and NPV of the most common SARS-CoV-2 diagnostic tests; and, (2) discusses its diagnostic interpretation in different clinical settings.
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Individuals over 65years are the fastest expanding population throughout the world, due to the increase in human life expectancy. This growing geriatric population, with increasingly associated chronic diseases, has relevant medical, social, and economic impact. Aging is characterized by progressive structural and functional changes in the kidney and in the cardiovascular system, leading to decline in renal function and hypertension. The purpose of this review is to describe the aging-related renal changes and blood pressure regulation during the aging process, their impact with regards to morbidity and mortality in these patients, and to summarize the most appropriate therapeutic approaches in these situations based on the particularities of this population group.
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Observational Study
Drug abuse during pregnancy and its neonatal impact. Analysis of the periods 2002-2008 and 2009-2017.
To determine the prevalence of substance abuse among our pregnant women and the characteristics of their pregnancies, deliveries and new-born infants. ⋯ The increase in cannabis use and the decrease in heroin and cocaine use have improved gestational control. Methamphetamine use is associated with serious social risks.
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) are both complications linked with COVID-19. Lower limb point-of-care clinical ultrasound (POCUS) could detect occult clots, helping decide whom to treat with anticoagulation. ⋯ Screening lower extremities with POCUS did not find a high rate of DVT among patients receiving LMWH-prophylaxis. However, there was a noteworthy amount of PE without DVT.
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The outbreak of novel coronavirus pneumonia 2019 (COVID-19) has caused millions of deaths worldwide. It is well documented that troponin predicts the prognosis of patients. Myoglobin is not only an important marker of myocardial injury, but it indicates systemic muscle damage. However, its relationship with COVID-19 was rarely reported. The present study compared the predictive value of troponin and myoglobin on the final prognosis of COVID-19 patients by analyzing the clinical characteristics and serum levels of myoglobin and troponin in severe/critical COVID-19 patients. ⋯ In severe/critical COVID-19 patients, myoglobin and troponin were predictors of mortality and the probability of conversion to critical illness, and myoglobin may be superior to troponin for predictive value.