ABSTRACT
La actual pandemia COVID 19 ha sido dramática, por su capacidad de contagio y mortalidad. Esta circunstancia necesita del cuidado mantenido, inherente al ser humano por su vulnerabilidad. La medicina representa la forma más humanitaria del cuidado. Quienes la ejercen deben tener una formación continua, que conjugue ciencia y técnica con ética y humanismo, y ser capaz de una comunicación veraz hacia quien demanda ayuda. La reumatología ha debido también enfrentar esta pandemia. Siendo eminentemente clínica, ha visto obstaculizado el encuentro presencial, por potenciales riesgos para médico y paciente. La telemedicina aparece como opción. Sin embargo, más allá de permitir, en esta contingencia, un mejor control y apoyo al paciente, existe reserva que en tiempos normales reemplace a un encuentro presencial. Si bien permite la comunicación con el paciente, carece del examen físico, fundamental en reumatología, que posibilita explorar en forma amplia la corporalidad del paciente como un todo.
The current COVID 19 pandemic has been dramatic, due to its contagion and mortality capacity. This circumstance needs the maintained care, inherent to the human being due to his vulnerability. Medicine represents the most humane form of care. Those who exercise it must have continuous training, which combines science and technique with ethics and humanism, and be capable of truthful communication towards those who demand help. Rheumatology has also had to face this pandemic. Being eminently clinical, it has been hampered the face-to-face meeting, by potential risks for doctor and patient. Telemedicine appears as an option. However, beyond allowing, in this contingency, better control and support for the patient, there is a reservation that in normal times it will replace a face-to-face meeting. Although it allows communication with the patient, it lacks the physical examination, fundamental in rheumatology, which makes it possible to explore the patient's whole body as a whole.
Subject(s)
Humans , Rheumatic Diseases/therapy , Telemedicine , Patient-Centered Care , Pandemics , COVID-19 , Rheumatology , Ethics, MedicalABSTRACT
Several recent open studies suggest that the response rates of lupus nephritis to intravenous (IV) cyclophosphamide are lower than those observed in clinical trials. One explanation could be ethnic differences; for example, black patients more frequently have treatment-resistant lupus nephritis. Another could be the inclusion of patients who are noncompliant with therapy. From our register of 268 systemic lupus erythematosus (SLE) patients examined between 1973 and 1996, 61 patients were treated for proliferative lupus nephritis (17 had World Health Organization [WHO] type III and 43 had WHO type IV) and were followed through to 2001. Exclusion criteria included a serum creatinine level >3 mg/dL. In this retrospective study, we assessed renal outcome and survival with an endpoint of end-stage renal disease (ESRD) or death (Kaplan-Meier). In the univariate analysis, worse prognostic factors for survival were serum creatinine >1.3 mg/dL (p < 0.001), age <30 years (p < 0.001), class 2 renal function stage (p < 0.03), and renal biopsy activity index >7 (p < 0.02). In the subgroup of 26 patients treated with IV cyclophosphamide, survival at 5 and 10 years was 82% and 73%, respectively. The dosage of IV cyclophosphamide was slightly lower than usual and used for a shorter period (median = 23 months) than what is usually recommended because of the high frequency of complications. Renal outcome of the IV cyclophosphamide-treated patients was poorer than that reported in the National Institutes of Health series (ESRD: 15% versus 3%). This low survival rate could reflect the short course and lower doses of IV cyclophosphamide used or ethnic differences. These data emphasize the need for continuous research for better-tolerated drug schemes for treatment of our lupus nephritis patients.
