Este es un blog medico que nunca podrá sustituir el buen juicio médico en la toma de decisiones.Intentamos compartir con los profesionales nuestras experiencias, conocimientos,lecturas,etc con la finalidad de mejorar la practica clinica.No es un blog para pacientes aunque no rechazamos sus comentarios
Recomendaciones de la ACR/AFR para OA mano, cadera y rodilla
El Colegio Americano de Reumatología junto con la Fundación de Artritis (ACR/AFR) ha desarrollado una guía para el manejo integral de la osteoartritis (OA), actualizando las recomendaciones para el manejo de la OAde la mano, cadera y rodilla, basándose en la evidencia que apoya los beneficios y daños de las terapias educativas, conductuales, psicosociales, mentales y farmacológicas disponibles.
Pre-existing immunity to SARS-CoV-2: the knowns and unknowns
Alessandro Sette &
T cell reactivity against SARS-CoV-2 was observed in unexposed people; however, the source and clinical relevance of the reactivity remains unknown. It is speculated that this reflects T cell memory to circulating 'common cold' coronaviruses. It will be important to define specificities of these T cells and assess their association with COVID-19 disease severity and vaccine responses.
Convergent antibody responses to SARS-CoV-2 in convalescent individuals
,
This is an unedited manuscript that has been accepted for publication. Nature Research are providing this early version of the manuscript as a service to our authors and readers. The manuscript will undergo copyediting, typesetting and a proof review before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers apply.
Around 80% of people with COVID-19 experience mild to moderate symptoms. Twenty percent develop severe disease. The challenge for practitioners in primary care is to identify those patients who require immediate assessment, those who can self-manage in the community, and those who may require further monitoring.
Remit and target users
This evidence review addresses prognostic factors which may indicate progression to severe disease. Key findings are presented on the identification of symptoms, characteristics, comorbidities and clinical signs in adults which may indicate a higher risk of progression to severe disease. This review complements the Scottish Government's COVID-19 Scottish Primary Care Hub Triage Guide and should be used alongside it.
Una buena noticia: el virus SARS-CoV-2 tiene su talón de Aquiles; la proteína de la espícula.
Además con este panel de anticuerpos neutralizantes se demuestra que una vacuna que estimule estos anticuerpos será efectiva.(jose manuel bautista twitter @1000genes)
Antibodies are a principal determinant of immunity for most RNA viruses and have promise to reduce infection or disease during major epidemics. The novel coronavirus SARS-CoV-2 has caused a global pandemic with millions of infections and hundreds of thousands of deaths to date1,2. In response, we used a rapid antibody discovery platform to isolate hundreds of human monoclonal antibodies (mAbs) against the SARS-CoV-2 spike (S) protein. We stratify these mAbs into five major classes on the basis of their reactivity to subdomains of S protein as well as their cross-reactivity to SARS-CoV. Many of these mAbs inhibit infection of authentic SARS-CoV-2 virus, with most neutralizing mAbs recognizing the receptor-binding domain (RBD) of S. This work defines sites of vulnerability on SARS-CoV-2 S and demonstrates the speed and robustness of advanced antibody discovery platforms.
Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway
Abstract
Background The 2-week wait referral pathway for suspected colorectal cancer was introduced in England to improve time from referral from a general practitioner (GP) to diagnosis and treatment. Patients are required to be seen by a hospital clinician within 2 weeks if their symptoms meet the criteria set by the National Institute for Health and Care Excellence (NICE) and to start cancer treatment within 62 days. To achieve this, many hospitals have introduced a straight-to-test (STT) strategy requiring hospital-based triage of referrals. We describe the impact and learning from a new pathway which has removed triage and moved the process of requesting tests from hospital to GPs in primary care.
Method An electronic STT pathway was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. The hospital identified referrals as being on a cancer pathway and dealt with all ongoing management. Routinely collected cancer data were used to identify time to cancer diagnosis compared with national data
Results 11357 patients were referred via the new pathway over 3 years. Time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway.
Conclusion We have changed the way patients with suspected colorectal cancer are managed within the National Health Service by giving GPs the ability to order tests electronically within a monitored cancer pathway halving time from referral to diagnosis
Coronavirus is instigating new thinking in diagnostics, such as face masks that can detect viruses on a wearer's breath or paper-based microfluidics for pathogen identification in low-resource settings.
Síntomas y signos para determinar si un paciente que acude a servicios de atención primaria o a servicios ambulatorios de un hospital tiene la enfermedad covid‐19
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Resumen
available in
Antecedentes
Algunas personas con infección por SARS‐CoV‐2 permanecen asintomáticas, mientras que en otras, la infección puede causar la enfermedad covid‐19 leve a moderada y la neumonía por covid‐19, que lleva a algunos pacientes a necesitar cuidados intensivos y, en algunos casos, a la muerte, especialmente en los adultos mayores. Síntomas como la fiebre o la tos, y signos como la saturación de oxígeno o los hallazgos de la auscultación pulmonar, son la primera información de diagnóstico y la más disponible. Esa información podría utilizarse para descartar la enfermedad covid‐19, o para seleccionar a pacientes para realizar más pruebas de diagnóstico.
Objetivos
Evaluar la exactitud diagnóstica de los signos y síntomas para determinar si un paciente que acude a servicios de atención primaria o a servicios ambulatorios de un hospital, como el servicio de urgencias o a centros especiales para la covid‐19, tiene la covid‐19 o neumonía por covid‐19.
