Introducción. Actualmente, hay pocos estudios en Latinoamérica sobre las características demográficas, clínicas y de laboratorio de pacientes con COVID-19 y con requerimiento de ingreso a unidad de cuidados intensivos (UCI). Objetivo. Comparar las características sociodemográficas, clínicas, imagenológicas y de laboratorio de pacientes diagnosticados con COVID-19 atendidos en el servicio de urgencias de una clínica en Cali, Colombia, según requerimiento de ingreso a UCI. Materiales y métodos. Estudio retrospectivo descriptivo de cohorte única realizado en 49 adultos con COVID-19 atendidos en el servicio de urgencias de un hospital de cuarto nivel de atención en Cali, Colombia, en marzo y abril de 2020, los cuales se dividieron en dos grupos: requerimiento de UCI (n=24) y no requerimiento de UCI (n=25). Se realizaron análisis bivariados para determinar las diferencias entre ambos grupos (pruebas de chi-2, exacta de Fisher, t de Student y U de Mann-Whitney), con un nivel de significancia de p<0.05. Resultados. La edad promedio fue 53 años (DE=13) y 29 pacientes fueron hombres. Se encontraron diferencias significativas entre ambos grupos en las siguientes variables: edad promedio (UCI x̅=58 vs. No UCI x̅=49; p=0.020), presencia de diabetes (8 vs. 1; p=0.010), presencia de dificultad respiratoria (20 vs. 11; p=0.007), presencia uni o bilateral de áreas de consolidación (12 vs. 3; p=0.005), mediana del conteo de leucocitos (Med=7570/mm3 vs. Med=5130/mm3; p=0.0013), de neutrófilos (Med=5980/mm3 vs. Med=3450/mm3; p=0,0001) y linfocitos (Med=865/mm3 vs. Med=1400/mm3; p<0,0001), mediana de proteína C reactiva (Med=141,25mg/L vs. Med=27,95mg/L; p<0,001), ferritina (Med=1038ng/L vs. Med=542,5ng/L; p=0.0073) y lactato-deshidrogenasa (Med=391U/L vs, Med=248,5U/L, p=0,0014). Finalmente, 15 pacientes requirieron ventilación mecánica invasiva, 2 presentaron extubación fallida, y en total, 5 fallecieron. Conclusiones. Se observaron diferencias significativas en los valores de varios marcadores inflamatorios, daño celular y parámetros del hemograma entre los pacientes que requirieron admisión a la UCI y los que no, por lo que estas variables podrían emplearse para desarrollar herramientas que contribuyan a establecer el pronóstico de esta enfermedad.
Objectives: To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). Materials and methods: A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolled T2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34). The endpoints were evaluated using analysis of variance. Results: All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean ± SD patient age and body weight were 55.05 ± 7.58 years and 83.55 ± 9.65 kg, respectively. The mean ± SD duration of T2DM, glycated hemoglobin (HbA 1c ), and fasting plasma glucose (FPG) were 5.93 ± 2.98 years, 8.1 ± 0.53%, and 166.03 ± 26.80 mg/dL, respectively. The grand mean changes of HbA 1c , FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA 1c target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. Conclusion: The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA 1c , but also body weight and blood pressure, with statistically significant results.
IntroductionThe main factors that are involved in a correct adherence to the therapeutic recommendations in Bipolar Disorder includes aspects related to age, sex, ethnicity, socioeconomic level and characteristics of the illness associated with the severity, comorbidity and adverse effects related to previous medicine.ObjectivesTo analyse the individual perception that the patient with Bipolar Disorder has regarding the positive and negative aspects of taking the recommended medication.MethodsDescriptive and interpretative observational study under the qualitative paradigm of research, extracting the data through the completion of four focus groups with ten patients everyone. To complete the codification of the content of the participant’s discourses, we rely on the QRS NVivo 10 computer program.ResultsIn the participant’s discourse concerning the main barriers to pharmacological treatment, for example “It’s because we live in a society and, because of that, we don’t go without medicine; if we didn’t live in society, we wouldn’t take medicine because we wouldn’t bother anyone”. Some examples of patient’s discourse, about perceived facilitators were: “I have to take medicine for my bipolar disorder, that’s it, I have a treatment, my illness has a name”.ConclusionsThe main facilitators regarding the use of pharmacological treatment in Bipolar Disorder are the perceived need for treatment in the acute phase and the recognition of the illness, the shared clinical decision and the causal biological attribution in the chronic phase. About perceived barriers, social control is identified in both phases, adverse effects in the acute cases and the absence of effective treatment in the chronic state.
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