Medicina clinica
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Etiological diagnosis of community-acquired pneumonia (CAP) is only reached in 30-40% of cases, which frequently requires keeping empirical antibiotic regimens. The new nucleic acid amplification techniques (NAAT) in respiratory samples raise the possibility of improving this clinical practice. Our objective was to analyze TAANs contribution estimating both their costs and benefits. ⋯ 64 cases were documented. An etiological diagnosis was made in 65.6%: 10.9% were obtained by conventional techniques and the rest (54.7%) by TAAN. These tests' results led to antimicrobial regimen's modification in 88.9% of cases and isolations in 78.5% CONCLUSIONS: Compared to TAAN's economic cost, it is worth considering its contributions, such as antimicrobials' reduction, ecological pressure, and isolations' indications.
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The value of carotid ultrasound in real-world practice remains controversial. We investigated the outcomes of people with vascular risk factors according to an easy carotid-plaque burden scale (CPB-scale). Predictive yield of the addition CPB-scale to ESC-SCORE2 (CPB-SCORE2 table) was assessed. ⋯ A simple prognostic CPB-scale was strongly associated with the long-term risk of developing a first MACE and all-cause death. Adding the CPB-scale to the SCORE2 may improve risk prediction with easy applicability in clinical practice.
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Cardiac implantable electronic devices have transformed medicine as they improve quality of life and prevent premature death. In palliative care settings, deactivation of these devices must be discussed, particularly at end-of-life. In terminally ill patients it is consensual to recommend implantable cardioverter defibrillator deactivation once shocks are frequent and painful. ⋯ Regarding cardiac resynchronization therapy, deactivation is not recommended as it can worsen symptoms. Left ventricular assistance device deactivation at end-of-life is a well-accepted practice, since it has the benefit of ending the physical burden associated with the device. Advance care planning should be encouraged and patients should be informed that deactivation is possible.