ABSTRACT
Resumen Presentar una serie de casos de COVID-19 con requerimiento de ingreso a Unidad de Cuidados Intensivos. La información fue tomada de las historias clínicas, y su evaluación y diagnóstico fue realizado mediante estudios paraclínicos en sangre, orina, PCR e imágenes diagnósticas en 4 pacientes con diferentes comorbilidades y nexo epidemiológico presente para desarrollo de la enfermedad. Los cuatro casos fueron manejados con cloroquina 300 mg vía oral, cada 12 horas, y azitromicina 1 gr vía oral, cada 24 horas, durante 5 días, sin complicaciones ni toxicidad asociada. El caso 1 desarrolló falla orgánica múltiple, incluyendo injuria renal aguda con una estancia en UCI de 4 días antes de su fallecimiento, mientras los casos 2, 3 y 4 tuvieron una evolución favorable y fueron dados de alta de UCI. Se requieren estudios multicéntricos rápidos que orienten científicamente hacia un mejor abordaje diagnóstico y manejo, en el contexto de una enfermedad con un comportamiento clínico-epidemiológico que debe estudiarse en profundidad y que probablemente cobrará muchas vidas; además, debido a la ausencia de pruebas diagnósticas rápidas, la utilización de una clasificación basada en la severidad de lesiones radiológicas llamada CO-RADS (Covid-19 Imaging Reporting and Data System) podría ser de gran importancia para instalar de manera temprana los tratamientos farmacológicos disponibles y la asistencia respiratoria mecánica precoz.
Abstract To present a COVID-19 case series with clinical admission criteria to Intensive Care Unit. Patients information was obtained from medical records, and daily clinical evaluation whereas diagnosis was carried out through paraclinical studies in blood, urine, PCR and diagnostic images in 4 patients with different comorbidities and epidemiological link for the development of COVID-19. All four cases were managed with chloroquine 300 mg orally every 12 hours and azithromycin orally every 24 hours for 5 days without complications or associated toxicity. The case 1 developed multiple organ failure, including acute kidney injury with an ICU stay of 4 days before his death, while cases 2, 3 and 4 had a favorable evolution and were discharged from the ICU. Rapid multicenter studies are required to scientifically guide a better diagnostic and management approach, in the context of a disease with a clinical-epidemiological behavior that must be studied in depth and will probably take many lives. In addition, due to the absence of sufficiently rapid tests, the use of a classification based on the severity of radiological lesions called CO-RADS (Covid-19 Imaging Reporting and Data System) could be of great importance to install available pharmacological treatments early and early mechanical respiratory support.
Subject(s)
Humans , Male , COVID-19 , Hospitalization , Patients , Colombia , Critical Care , Diagnosis , Intensive Care UnitsABSTRACT
The goal of critical care support is to prevent premature death and to reduce the morbidity and suffering of the critically ill patients by intensive therapy for reversible illness within optimal timeframe. Undesirable quality of critical care service in Korean hospitals necessitates system-level change in the organization of critical care. The causes of critical care system failure are multifactorial, including unreasonable critical care reimbursement system, shortage of critical care professionals, and unacceptable level of legal standard for the critical care delivery system. The Korean Society of Critical Care Medicine (KSCCM), which was established in 1980, has been trying to improve critical care delivery system. The Society believes that improving ICU care can be achieved by standardizing the critical care initiated by dedicated full-time critical care physicians. To achieve this goal, the Society has attempted to include the critical care specialty as a part of our medical society during the past five years. On April 15th, 2008, the Society established a critical care specialty under the endorsement of the Korean Academy of Medical Societies. The Society believes that implementation of the critical care specialty and the core critical care education and training system can significantly enhance the quality of critical care and patient outcomes in Korean medical institutions. In order to create the high-quality critical care through the successful critical care team approach, we should reform the present critical care delivery system, and re-prioritize medical resources together with relevant legal support. For this, a long-term task force team consisting of all involved stakeholders including policy makers should be operated. The task force team has to play a central authority to implement and regulate the enhanced critical care system effectively to Korean hospitals. The reformation of critical care system should not be delayed, since intensive care unit is the last resort for the critically ill patients.
Subject(s)
Humans , Administrative Personnel , Advisory Committees , Critical Care , Critical Illness , Health Resorts , Intensive Care Units , Mortality, Premature , Societies, Medical , Stress, PsychologicalABSTRACT
OBJECTIVES: This review strives to look through the reality of school situation in Korea which gives the most severe burden of conflict to adolescents nowadays, for the purpose of better understanding of them. METHODS: Followings comprised of the summary of the materials from the published articles and books, and from mass media regarding 'school collapse' phenomenon in Korea, and also include materials regarding school non-attenders. And discussion was done with developmental and psychiatric perspectives on the phenomenon along with on school non-attenders. CONCLUSION: School non-attenders nowadays with the issue of 'school collapse' have different characteristics from the dropouts reported in many previous studies. Psychiatrists need to accommodate their previous view on adolescents as the way of adolescents' coping has rapidly changed. It is noted that there are few researches regarding school non-attenders, as well as regarding school factors associated with non-attending in Korea. This review was done to call for future studies focused on the interdependent relationship between school processes and the individual characteristics of non-attenders, so that enable us to capture the complexity of how adolescents make their decision of hangingin or droppingout of school.