Search

Objective: To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service., Methods: Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses., Results: Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case., Conclusions: The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

In 2018, the Colombian Ministry of Health and Social Protection, in collaboration with the National Health Institute and the Pan American Health Organization, convened all actors associated with the National Tuberculosis Prevention and Control Program (PNPCT) and the National Science, Technology, and Innovation System to form a national network to coordinate operations research on tuberculosis (TB) in the country. Seven workshops were held and a consensus was reached to establish the National Network for Knowledge Management, Research, and Innovation in Tuberculosis in Colombia (TB Colombia Network). With more than 180 participants, a central node, and five regional nodes that bring together the country's 37 territorial entities, the TB Colombia Network conducted four days of training in operations research in 2019, defining 65 priority research topics aligned with the strategic lines in the PNPCT: prevention and comprehensive care, with a focus on people affected by TB (41 topics in three modules); and political commitment, social protection, and support systems (24 topics in four modules). The peer comparison method was used for prioritization. The TB Colombia Network remains active and contributes to knowledge management aimed at eliminating TB in Colombia. It has helped make progress in building plans and implementing local operations research projects that generate scientifically validated results to strengthen the PNPCT and improve the care of TB patients.

Communities That Care (CTC) is a prevention system aimed at reducing antisocial behaviors in adolescents. In Colombia, this system has been developed and adapted under the name of Comunidades Que se Cuidan (CQC). Successful implementation of CQC depends on valid associations between measured risk and protective factors (RPFs) for substance use and substance use outcomes. This study assessed these associations using large-scale, school-based surveys of Colombian youth. A cross-sectional analysis was performed. Data from 23 communities in Colombia were collected between 2012 and 2016 from young people (N = 50,946) aged 10 to 19 years. Dichotomous alcohol, cigarette, cannabis, and other illegal drug use outcomes were assessed for past 30-day, past-year, and lifetime use. Logistic regression analyses, adjusting for age, gender, and age by RPF, and gender by RPF interactions, were performed for each RPF. All the associations of the 14 RPF evaluated were statistically significant (p<,001). Regarding observed effect sizes, 3.0% were considered very small (0.70 ≥ OR ≤ 1.43), 51.7% small (0.70 ≥ OR ≥ 1.43), 42.6% medium (0.40 ≥ OR ≥ 2.48) and 7.1% large (0.23 ≥ OR ≥ 4.27). Significant main effects for age and gender, and their interactions with RPFs were found for most RPFs. Findings from this study demonstrate the viability of RPFs for adolescent substance use as focal points for intervention planning, development, and evaluation of community-based prevention systems like CQC that rely on epidemiologic data for local decision making.

Aims: To identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTR)., Design: An observational, retrospective, nested cases-controls study from a consecutive cohort of LTRs was carried out., Setting: University hospital., Patients: All consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients., Main Variables of Interest: Pretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na)., Results: The MELD-Na score (OR = 1.069, 95% CI = 1.014-1.127), age > 60 years (OR = 2.479, 95% CI = 1.226-5.015), and LTR height < 163cm (OR = 4.092, 95% CI = 2.115-7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor., Conclusions: In LTR due to decompensated cirrhosis, the MELD-Na score, age > 60 years, and height < 163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality., (Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Introduction: metabolic syndrome (MS) is a health problem associated with diabetes and cardiovascular diseases. The prevalence of MS in adolescents from Morelos is unknown. Certain risk eating behaviors (REB) may be associated with this phenotype., Objective: to determine the prevalence of MS in adolescents and its association with REB., Methods: cross-sectional study in junior high schools and high schools from Morelos. Anthropometric, clinical data, perception of body image and REB were investigated. MS was diagnosed with international criteria for adolescents and their association with REB was analyzed. Logistic regression analysis was utilized to estimate adjusted odds ratios (ORadj) and 95% confidence intervals (CI95)., Results: a total of 869 adolescents aged 14.6 ± 1.6 years were studied. They reported 2.6 ± 1.8 REB; the overall score was 5.9 ± 0.33. The 16.6% presented moderate or high REB risk. The prevalence of MS (6.7%) was associated with the REB score (OR 1.2 [1.1-1.3]), a value that remained after adjusting for age, sex, breakfast omission, residence region, perception of body image and background family of obesity, diabetes, hypertension or infarction (ODHI), ORadj 1.2 (1.1-1.3), pseudo R2 = 0.14, Chi-squared 16.7, p < 0.03., Conclusion: MS was more frequent in men, who were perceived to be thinner and with two or more family history of ODHI. It is suggested to influence the self-perception of overweight or obesity, to educate about compulsive behaviors, undergo diets, fasting and exercise to prevent MS.

The objective was to detect Gram-negative bacilli and Gram-positive cocci isolated from the environmental microbiota of the Intensive Care Unit (ICU) departments of Neonatology, Pediatrics, and Transplants (kidney, liver, and general) in a Lima hospital and determine their antimicrobial sensitivity. Eighty samples were obtained from inanimate surfaces using a wet swab. A total of 61 bacterial strains were identified, including Staphylococcus epidermis (46.0%), Alcaligenes sp. (21.3%), Pseudomonas aeruginosa (16.4%), Acinetobacter sp. (13.1%), Staphylococcus aureus (1.6%), and Staphylococcus haemolyticus (1.6%). Acinetobacter sp. and P. aeruginosa showed a heightened sensitivity to the antibiotics assessed, while Alcaligenes sp. and S. epidermidis presented the highest antimicrobial resistance. It is recommended that sustained asepsis and monitoring methods be used in ICUs.

For more than two years, Corporación Nuevos Rumbos (Colombia) has been carrying out, in eight Colombian communities, a preventive system called Comunidades Que se Cuidan (CQC), an adaptation of Communities That Care (CTC), created at the University of Washington (Seattle), developed for more than 25 years in the United States of America and implemented in eight countries of America, Oceania, and Europe. The system is based on the public health approach, and the social development strategy for community empowerment. The core idea is to teach communities how to make decisions based on data regarding drugs and alcohol consumption and the identification of protective and risk factors, on the basis of the original survey validated in Colombia: these will allow communities to choose the best preventive interventions, tailored for each of them according to their needs. This paper describes the process of implementation of CQC in Colombia, its differences with CTC, the creation of Colombian cut-points, the main difficulties and how these were solved. CQC seems to be a preventive system with a wide potential applicability in other Latin American countries.

Background: Prehepatic portal hypertension in children can be asymptomatic for many years. Once diagnosed, the therapeutic measures (pharmacologic, endoscopic, and surgical) are conditioned by the specific characteristics of each patient. In Mexico, there are no recorded data on the incidence of the disease and patient characteristics., Aims: To determine the main clinical, radiologic, and endoscopic characteristics upon diagnosis of these patients at the Instituto Nacional de Pediatría within the time frame of January 2001 and December 2011., Methods: A cross-sectional, retrolective, descriptive, and observational study was conducted in which all the medical records of the patients with portal hypertension diagnosis were reviewed., Results: There was a greater prevalence of prehepatic etiology (32/52) (61.5%) in the portal hypertension cases reviewed. Males (62.5%) predominated and 11 of the 32 patients were under 4 years of age. The primary reason for medical consultation was upper digestive tract bleeding with anemia (71.9%) and the main pathology was cavernomatous degeneration of the portal vein (65.6%). Splenoportography was carried out on 17 of the 32 patients. A total of 65.5% of the patients received the combination therapy of propranolol and a proton pump inhibitor. Initial endoscopy revealed esophageal varices in 96.9% of the patients, 12 of whom presented with gastroesophageal varices. Congestive gastropathy was found in 75% of the patients. The varices were ligated in 8 cases, sclerotherapy for esophageal varices was carried out in 5 cases (15.6%), and sclerotherapy for gastric varices was performed in 2 patients. Seventeen patients (53.1%) underwent portosystemic diversion: 10 of the procedures employed a mesocaval shunt and 7 a splenorenal shunt. Nine patients (28.1%) underwent total splenectomy., Conclusions: The primary cause of the disease was cavernomatous degeneration of the portal vein; it was predominant in males and the first symptom was variceal bleeding., (Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Background: Cow's milk protein allergy (CMPA) is being seen more frequently on a daily basis in pediatric consultations. It shares symptoms with gastroesophageal reflux (GER), which can complicate the differential diagnosis., Aims: To attempt to corroborate the presence of acid GER in children with CMPA, as well as to find a characteristic profile through the 24-hour pH monitoring study in children with GER and CMPA METHODS: The intraesophageal pH monitoring studies performed on 47 children with CMPA were reviewed. The measurements in all the studies were carried out within a 24-hour period using Digitrapper® equipment with a multi-use GeroFlex® catheter, after calibration with pH 7 and pH 1 buffer solutions., Results: Of the 47 children, 23 were boys (32.4%) and 24 were girls (33.8%) and the mean age was 5±3.7 years. Fourteen of the 47 children (29%) presented with GER, according to the result of the 24-hour intraesophageal measurement. Only 2 of the 47 patients studied fit the phasic profile., Conclusions: The findings show the existing relation between the two pathologies. Nevertheless, it is important to determine the presence of non-acid or weak acid reflux, because their existence can increase this association., (Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix complex, endemic in Abancay, Peru. Is acquired by traumatic inoculation with plant material. Common clinical presentations are lymphatic cutaneous and fixed cutaneous disease. We report 2 cases of fixed cutaneous sporotrichosis with granulomatous appearance. The first case was a patient of 65 years old with no risk factors and the second case was a 67 year old diabetic patient. Subjects underwent mycological culture with Sabouraud agar, with isolation of Sporothrix schenckii and clinical dignosis of fixed cutaneous sporotrichosis with granulomatous appearance. One patient received oral treatment with saturated solution of potassium iodide (SSKI) with a initial dose of 3 drops tid up to a maximum dose of 40 drops tid. Mycological and clinical cure was achieved after 2 months of treatment. We should consider the unusual clinical presentations of fixed cutaneous sporotrichosis with granulomatous appearance that present morphological and clinical features in diabetic and nondiabetic patients older than 60 years from endemic areas and communicate adequate response to treatment with SSKI in one case.

A descriptive study was conducted between the months of May and August 2008 in Santa Teresa Medical Center, Abancay. Of 33 patients clinically suspected with Sporotrichosis: 20 patients were identified with Sporothrix schenckii. 11 (55%) of patients were males. Children between 0 and 14 years were most affected. 60% of the lesions were fixed cutaneous being more frequent in the head and neck (40%). 55% had lessions for less than one month. In pediatric population with involvement of head and neck, Sporotrichosis should be considered in the differential diagnosis of skin lesions of patients from endemic areas.

Background and Objective: The aim of the study was to compare the quality of life of elderly patients undergoing aortic valve replacement with that of a reference group., Patients: A total of 163 patients aged 75 years who underwent aortic valve replacement were analyzed. Quality of life was evaluated by the Short Form Health Survey test 12 (SF-12). The median follow-up period was 37.4 months. Quality of life follow-up was complete at 95.6% of mid-term survivors. Quality of life data was compared with published data of a sample of the Spanish population (n.1312) of the same age and same sex., Results: Overall 30-day mortality was 7.4%. The mean SF-12 physical component score and SF-12 mental component score of the study population were 44,69 and 49,88 for woman and 47,38 and 56,19 for men, respectively. Our sample population showed a post operative quality of live comparable with that of the general population., Conclusions: Elderly patients who are candidates to aortic valve replacement represent a high risk population. Nevertheless, the quality of life achieved post-operatively is comparable with that of the general population.

Background: Chronic urticaria is a multifactorial disease classified in three main groups: mechanical, autoimmune and idiopathic. So far we don't know the mechanisms that produces it, there are different theories and one of them is the presence of Helicobacter pylori., Objective: To establish the relation between chronic urticaria and Helicobacter pylori trough endoscopic and histopatological studies., Patients and Methods: Seventy-two patients older than 18 years old, 36 with chronic urticaria and 36 controls with the same sex and age. Complete clinical history, hematical biometry, cutaneous determination of IgE and tests was made to each one. High panendoscopy with gastric biopsy was asked to practice Warthin Starry method and determine Helicobacter pylori existence. The statistical analysis was made with SPSS program, version 11, to establish the bivariated correlation in search of variables dependency., Results: In the group with chronic urticaria, there were 19 (52.8%) patients infected with Helicobacter pylori, and in the control group only 4 (11.1%). We found a chi2 with a value of 12.52 (p < 0.002)., Conclusions: Association between chronic urticaria and Helicobacter Pylori is evident, so we propose a routinely scan for this microorganism in patients with the disease.

The follow-up of HBV markers in selected high infection risk populations, in patients from the hemodialysis and peritoneal dialysis services was used to assess the effectiveness of a special vaccination program. Viral infection markers were studied in prevalence cross sections of the whole population of patients, and also by recording the reports of clinical cases of hepatitis B occurred during that period in those groups of patients. The prevention program consisted of the vaccination of all patients negative to the viral markers and the indication of vaccination for the new cases during the period of the kidney disease, just before the start of the treatment at the hemodialysis unit; besides all the persons susceptible to infection that had already been included in the program, regardless of the stage of the disease. The results show the benefit of the vaccination in these patients, but it is more effective in the period before the treatment with dialysis where there is a lower possibility of being exposed to the virus and the immune system is still competent. Once the program was established, after a follow up o 6 years, there have been no reports of new cases of hepatitis B and the incidence of the disease has been declining.

During the twenty years in which nursing has been taught as a university subject field, its teaching methods have undergone two stages: a first one about ten years long in which the change produced in the orientation toward nursing care originated a conceptual and methodological whirlwind advancing the profession in a way which had never before occurred; and a second stage in which the conceptual waters tend to subdue and the first doubts begin to appear about whether or not the profession is walking down the right path. This article proposes to serve as a reflection on the twenty year history of Nursing as a university subject field as well as to reflect on how we can construct the future on this base, not only in nursing studies themselves and the manner of teaching these studies, but in the profession as a whole. The author presented this as a conference at the Spanish Association of Nursing Teachers' XVIII "Working Days" Conference.

Cartilaginous tumors of the larynx are rare; although chondromas are the most frequent of these tumors. Laryngeal chondrosarcomas are even rarer, in spite of this being the most frequent histological variety of sarcoma (less than 1% of all malignant laryngeal tumors). These tumors are slow-growing, locally aggressive, and tend to recur. They are less aggressive in the larynx than in other sites: cervical or distant metastases are rare (8.5%) and recurrences often can be controlled. The most common presenting symptom is hoarseness with normal indirect laryngoscopy. The complementary studies of choice are computed tomography (CT) and magnetic resonance imaging (MRI). The role of these imaging techniques in the study of laryngeal chondroma and chondrosarcoma was examined. These sporadic tumors may be overlooked, although early identification is necessary for effective treatment.

A case of aortic valve endocarditis caused by Coxiella burnetii and operated on with success is reported. The patient is doing well at 18 months follow up. Diagnosis of Q-fever endocarditis was made by high antibodies against phase I Coxiella burnetii antigens titration and by demonstration of aortic valvular vegetations by bidimensional echocardiography. Our patient suffered emergency aortic valve substitution due to acute hemodynamic failure and started a long-term treatment with doxycycline and rifampicin. Some interesting aspects about the diagnosis and treatment of this patient are reviewed because long-term follow-up and serological controls are still rare in the literature.

The results of a validation study of the ultramicroanalitical assay for the detection of antibodies against the hepatitis B surface antigen (UMELISA anti-HBsAg), which was carried out by comparing the results obtained with the Hepanostika anti-HBsAg, commercial diagnosis kit are presented. For this purpose, sera from the clinical assays of the Cuban recombinant vaccine against hepatitis B were used. With the first sera group (n = 30) it was obtained, 93.1% of sensitivity, 98.5% of specificity and a concordance of 94.3%. The correlation coefficient showed a similar trend of the results (p < 0.01) and no significant differences were found in the average geometrical titre (TPG) between both assays (p > 0.05). With the second group (n = 100), whose assays were carried out at the "Pedro Kouri" Institute of Tropical Medicine (PKI) and at the Immunoassay Center (IAC) simultaneously, it was observed a sensitivity of 96.25% in both centers, a specificity of 75% at the PKI and of 90% at the IAC, and a coincidence of 92% and 95%, respectively. The correlation coefficient presented similar values and there were no significant differences between the TPG obtained by the two methods (p > 0.05). The results attained show in general the validity of the new assay and the feasibility to put it into practice either for following up the infection, or for carrying out clinical assays of vaccine evaluations.

Seventy (70) dissections of temporal bones of grown-up guinea pigs were done by the AA. in order to get a suitable approach to obtain inner ear studies, aiming at a morphological investigation.

Thirty nine patients with hydatiform mole with clinical, echosonographic and hormonal diagnosis, were analyzed, from March, 1991 to February 1993 at the Nuevo Hospital Civil de Guadalajara. Incidence was I out of 301 pregnancies; average age, 24.6 years; 35.8% were primigravidae; average amenorreha was 15.6 weeks and there were not complications in 84.6%. The most frequent symptoms were transvaginal bleeding, 92.3%; mole rests expulsion, 25.6% and hyperemesis, 23%. The uterine fundus was larger in 17 patients; smaller in 13; the same in 5 and there were no data for four cases. An uterine curettage was performed in 38 patients; there was hysterotomy performed also for important bleeding; and there were 11 patients transfused. The histopathologic results of hydatidiform mole were confirmed in 84.6%. Only 20% of the patients came back for a post-evacuation control treatment. These results suggest that the characteristics of mola pregnancy at the Nuevo Hospital Civil de Guadalajara are similar to what has been reported in the literature; with a delayed diagnosis and a poor follow up of cases.