Medicina
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The clinical features of COVID-19 differ substantially upon the presence (or absence) of viral pneumonia. The aim of this article was to describe the clinical characteristics of COVID-19 patients admitted to the Internal Medicine ward, as divided into those with and without pneumonia. This single-center prospective cohort study was conducted in a tertiary teaching public hospital in Buenos Aires City named Hospital General de Agudos Carlos G. ⋯ Among patients with COVID-19 pneumonia, in-hospital mortality rate was 6.6%, severe disease developed in 81 (33.3%), critical disease in 23 (9.5%), and 22 (9.1%) were admitted to the intensive care unit. A largely good prognosis was observed among COVID-19 patients without pneumonia, still, even among this group, unfavorable clinical progression can develop and should be properly monitored. Critical illness among patients with COVID-19 pneumonia was frequent and observed rates from this cohort provide a sound characterization of COVID-19 clinical features in a major city from South America.
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At the end of 2019 a novel coronavirus was identified as a cause of pneumonia in Wuhan, China. This emerging disease has caused an unexpected turn in the economy and in society, which has led to the necessity of social isolation and confinement. Diabetic foot consultation was affected by the ongoing situation. ⋯ During 2020, telehealth consults represented a 7% of all medical visits. There were no major amputations during 2019 and 4 during 2020. Given the dynamics of confinement, further studies about this topic are required to make sound and accurate decisions.
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The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. ⋯ In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.
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Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. ⋯ A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.
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On March 20, preventive and mandatory social isolation due to COVID-19 was implemented in Argentina. Since then, the importance of caring for cardiovascular diseases has been emphasized. The objective of this retrospective cohort study was to analyze the association between social isolation and severe arterial hypertension (systolic = 160 mmHg and / or diastolic = 100 mmHg) in the Emergency Service of the Hospital Universitario Fundación Favaloro. ⋯ During the period after the lockdown implementation, 1634 patients were admitted, 53.8% less than in the pre-lockdown implementation period; 23.9%, in the post-lockdown period, registered severe arterial hypertension, significantly more than in the pre-lockdown period (15.5%) and in the interannual comparator (17.6%). Consultation during the lockdown period was associated with severe arterial hypertension in the simple model (odds ratio 1.58) and in the multivariate model (adjusted odds ratio 1.37). In conclusion, social isolation was associated with an increase in severe arterial hypertension in the Emergency Service, independently of biological factors (age, sex) and other potential confounders.