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La intoxicación por warfarina es poco común, pero puede provocar hemorragias potencialmente mortales. Lo ideal sería la dosis adaptada de vitamina K que da como resultado un INR terapéutico hasta que las concentraciones de warfarina se normalicen. Sin embargo, dicho método de tratamiento puede complicarse con rebote de INR y resistencia a warfarina. Presentamos el caso de un varon de 75 años con historial de hábito alcohólico que inició tratamiento con warfarina, concomitante a fluoxetina. Presentó un INR>10 con hemorragia mayor que se revirtió satisfactoriamente al tratamiento conservador con vitamina K y Plasma fresco congelado. La sobredosis en pacientes con tratamiento de anticoagulación oral asociado a una patología de base hace más complicado el tratamiento por la dificultad de alcanzar una reversión total. La heparinización es una opción adecuada hasta restablecer la warfarinización, pero prolonga la hospitalización. Un evento como el que se presenta puede cursar con diferentes complicaciones, susceptibles de exponer al paciente a una situación crítica con riesgo vital inminente; por lo que, un diagnóstico precoz y acciones terapeúticas oportunas pueden prevenir este riesgo.

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A pesar, de que hay reportes de casos en la literatura internacional, que asocian la enfermedad periodontal con enfermedades respiratorias y medidas para la prevención de la enfermedad periodontal inflamatoria, sino se establece un adecuado manejo de esta última, puede evolucionar con una complicación sistémica como es el absceso pulmonar. Objetivo: Ilustrar cómo la enfermedad periodontal inflamatoria puede asociarse a un absceso pulmonar como complicación sistémica en su evolución. Presentación del caso: Se presenta una paciente femenina con antecedentes de absceso periodontal y enfermedad periodontal crónica, los cuales constituyeron las únicas causas demostradas del desarrollo de un absceso pulmonar, tras la aplicación del método clínico. Conclusiones: La enfermedad periodontal inflamatoria puede evolucionar hacia la remisión si se adoptan las medidas protocolizadas para su tratamiento, sin embargo, siempre que esa enfermedad siga su curso natural o no se maneje adecuadamente puede evolucionar a complicaciones sistémicas como lo es el absceso pulmonar(AU)

Although there are in the international literature report of cases, which associate the peridental disease to respiratory diseases and measurements to the prevention of the peridental inflammatory disease, if there is not established an adequate usage of the last one, it can emerge with a systemic complication like lung abscess. Objective: To show how the peridental inflammatory disease can be associated to a lung abscess like a systemic complication in its evolution. Case Presentation: A female patience is presented with antecedents of peridental abscess and chronic peridental disease, which were the unique causes demonstrated in the development of a lung abscess, after the application of the clinic method. Conclusions: The peridental inflammatory disease can emerge towards the remission if some protocolic precautions are adopted for its treatment; nevertheless whenever the disease follows its natural course or it is not properly managed it can emerge to systemic complications like, it is the lung abscess(AU)

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Fundamento: A pesar, de que hay reportes de casos en la literatura internacional, que asocian la enfermedad periodontal con enfermedades respiratorias y medidas para la prevención de la enfermedad periodontal inflamatoria, sino se establece un adecuado manejo de esta última, puede evolucionar con una complicación sistémica como es el absceso pulmonar. Objetivo: Ilustrar cómo la enfermedad periodontal inflamatoria puede asociarse a un absceso pulmonar como complicación sistémica en su evolución. Presentación del caso: Se presenta una paciente femenina con antecedentes de absceso periodontal y enfermedad periodontal crónica, los cuales constituyeron las únicas causas demostradas del desarrollo de un absceso pulmonar, tras la aplicación del método clínico. Conclusiones: La enfermedad periodontal inflamatoria puede evolucionar hacia la remisión si se adoptan las medidas protocolizadas para su tratamiento, sin embargo, siempre que esa enfermedad siga su curso natural o no se maneje adecuadamente puede evolucionar a complicaciones sistémicas como lo es el absceso pulmonar.

Background: Although there are in the international literature report of cases, which associate the peridental disease to respiratory diseases and measurements to the prevention of the peridental inflammatory disease, if there is not established an adequate usage of the last one, it can emerge with a systemic complication like lung abscess. Objective: To show how the peridental inflammatory disease can be associated to a lung abscess like a systemic complication in its evolution Case Presentation: A female patience is presented with antecedents of peridental abscess and chronic peridental disease, which were the unique causes demonstrated in the development of a lung abscess, after the application of the clinic method Conclusions: The peridental inflammatory disease can emerge towards the remission if some protocolic precautions are adopted for its treatment; nevertheless whenever the disease follows its natural course or it is not properly managed it can emerge to systemic complications like, it is the lung abscess.

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A cost-effectiveness analysis was conducted in screening for breast cancer. The use of conventional mammography, digital and magnetic resonance imaging were compared with natural disease history as a baseline. A Markov model projected breast cancer in a group of 100,000 women for a 30 year period, with screening every two years. Four distinct scenarios were modeled: (1) the natural history of breast cancer, as a baseline, (2) conventional film mammography, (3) digital mammography and (4) magnetic resonance imaging. The costs of the scenarios modeled ranged from R$ 194.216,68 for natural history, to R$ 48.614.338,31, for screening with magnetic resonance imaging. The difference in effectiveness between the interventions ranged from 300 to 78.000 years of life gained in the cohort. The ratio of incremental cost-effectiveness in terms of cost per life-year gains, conventional mammographic screening has produced an extra year for R$ 13.573,07. The ICER of magnetic resonance imaging was R$ 2.904.328,88, compared to no screening. In conclusion, it is more cost-effective to perform the screening with conventional mammography than other technological interventions.

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O objetivo deste trabalho foi realizar análise de custo efetividade da intervenção das mamografias convencional e digital e da ressonância magnética no rastreamento de câncer de mama, comparando com o não rastreamento. Foi construído um modelo markoviano, numa uma coorte hipotética de 100 mil mulheres com rastreamento bianual, cuja linha de base é a história natural da doença. Modelaram-se quatro cenários distintos: (1) a história natural do câncer de mama como linha de base; (2) mamografia com filme convencional; (3) mamografia digital e (4) e ressonância magnética. Os custos dos cenários modelados variaram desde R$ 194.216,68 para a história natural, até R$ 48.614.338,31 para o rastreamento com ressonância magnética. As diferenças de efetividade entre as intervenções variaram de 300 até 78.000 anos de vida ganhos, na coorte de 100 mil mulheres. Em relação à Razão de Custo-Efetividade Incremental, em termos de custo por ano de vida ganhos, a estratégia do rastreamento mamográfico convencional produziu um ano extra por R$ 13.573,07. A Razão de Custo Efetividade Incremental (ICER) da ressonância magnética foi de R$ 2.904.328,88 em relação ao não rastreamento. O estudo mostrou que é mais custo-efetivo realizar o rastreamento com a mamografia convencional do que as outras tecnologias de intervenção.

A cost-effectiveness analysis was conducted in screening for breast cancer. The use of conventional mammography, digital and magnetic resonance imaging were compared with natural disease history as a baseline. A Markov model projected breast cancer in a group of 100,000 women for a 30 year period, with screening every two years. Four distinct scenarios were modeled: (1) the natural history of breast cancer, as a baseline, (2) conventional film mammography, (3) digital mammography and (4) magnetic resonance imaging. The costs of the scenarios modeled ranged from R$ 194.216,68 for natural history, to R$ 48.614.338,31, for screening with magnetic resonance imaging. The difference in effectiveness between the interventions ranged from 300 to 78.000 years of life gained in the cohort. The ratio of incremental cost-effectiveness in terms of cost per life-year gains, conventional mammographic screening has produced an extra year for R$ 13.573,07. The ICER of magnetic resonance imaging was R$ 2.904.328,88, compared to no screening. In conclusion, it is more cost-effective to perform the screening with conventional mammography than other technological interventions.

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