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Introduction: the aim of this study was to analyze the status of the management of vascular risk factors (hypertension and diabetes) at hospital level (3, 4 and 5) in Murang'a County (Kenya) health system. Methods: between July and December 2018 we performed a joint intervention about the strategies for improving care management of hypertension and diabetic patients in Murang'a (Kenya). A survey based on the recommendations from WHO about management of diabetes and hypertension was completed for 9 health-care centers. The survey made use of a semi-structured questionnaire, while the units of analysis for the survey were households. Results: the number of patients recorded at medical registers with diabetes and hypertension registered in public hospitals in Murang'a County were 6628 (0.45%) and y 6694 (0.45%), respectively. In the surveyed health-care centers, no hospital use electrogram and only one had troponin test. No hospital stocked Isosorbide dinitrate and Glicerine trinitate to prevent chest pain in patients with a heart condition. Only 3 of the clinics performed visual acuity examination and no facility did neurologic examination for neuropathy complications. No public hospital had HbA1 and did microalbuminuria test available. Conclusion: it is necessary to improve to establish screening methods, diagnosis, treatment and follow-up of patients with hypertension and diabetes in Murang'a County at the various levels of health care.

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OBJECTIVE: The delay caused to provide an appointment and the uncertainty of the expected waiting time, are cause for discontent in the patients. The object of this work was to improve the accessibility to the consultation of specialized attention in our health area, decreasing the average waiting time and reduce the number of claims for this reason. METHODS: To measure the quality of the service provided, 5 criteria were developed and evaluated, by means of a cross section, in December 2015 for all patients pending appointment in the Area. Likewise, the complaints and claims collected during the 6 months prior to this date were quantified. As an intervention, a new circuit was designed and implemented in the interconsultation process, protocolizing a direct and automatic citation system. This system also eliminated patients without an appointment, allowing prioritization in preferred cases. At the end of 2016, a new evaluation was made with the same methodology. For the statistical analysis, Student's t and Chisquare were used. RESULTS: In six months the number of patients without appointment was reduced from 4726 to 0. The average waiting time for external consultations improved from 63 to 44.2 days. Patients waiting more than 50 days increased from 41.5% to 74.8%. The number of complaints and claims due to appointment in external consultations decreased from 161 to 80. CONCLUSIONS: Accessibility has improved by reducing the average waiting time and eliminating the list of patients without an appointment, although the number of patients pending appointments for more than 50 days has increased. The number of complaints and claims has been halved.

OBJETIVO: La demora originada para proporcionar una cita y la incertidumbre del tiempo previsto de espera, son causa de descontento en los pacientes. El objetivo de este trabajo fue mejorar la accesibilidad a la consulta de atención especializada en nuestra área de salud, disminuyendo el tiempo medio de espera y reducir el número de reclamaciones por este motivo. METODOS: Para medir la calidad del servicio prestado, se elaboraron 5 criterios que se evaluaron inicialmente mediante un corte transversal, en diciembre de 2015, en todos los pacientes pendientes de cita en el Área. Así mismo se cuantificaron las quejas y reclamaciones recogidas los 6 meses anteriores a esta fecha. Como intervención, se diseñó e implementó un nuevo circuito en el proceso interconsulta, protocolizando un sistema directo y automático de citación. Este sistema eliminaba además los pacientes sin cita, permitiendo la priorización en los casos preferentes. Al final de 2016 se realizó una nueva medición con la misma metodología. Para el análisis estadístico se han usado la t de Student y la Chi cuadrado. RESULTADOS: En seis meses se redujo el número de pacientes sin cita de 4.726 a 0. El tiempo medio de espera en consultas externas pasó de 63 a 44,2 días. Los pacientes en espera de más de 50 días pasaron del 41,5% al 74,8%. El número de quejas y reclamaciones debidas a cita en consultas externas pasó de 161 a 80. CONCLUSIONES: Ha mejorado la accesibilidad al disminuir el tiempo de espera media y se ha eliminado la lista de pacientes sin cita, si bien ha aumentado el número de pacientes pendientes de cita de más de 50 días. Se ha reducido a la mitad el número de quejas y reclamaciones.

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Fundamentos: La demora originada para proporcionar una cita y la incertidumbre del tiempo previsto de espera, son causa de descontento en los pacientes. El objetivo de este trabajo fue mejorar la accesibilidad a la consulta de atención especializada en nuestra área de salud, disminuyendo el tiempo medio de espera y reducir el número de reclamaciones por este motivo. Métodos: Para medir la calidad del servicio prestado, se elaboraron 5 criterios que se evaluaron inicialmente mediante un corte transversal, en diciembre de 2015, en todos los pacientes pendientes de cita en el Área. Así mismo se cuantificaron las quejas y reclamaciones recogidas los 6 meses anteriores a esta fecha. Como intervención, se diseñó e implementó un nuevo circuito en el proceso interconsulta, protocolizando un sistema directo y automático de citación. Este sistema eliminaba además los pacientes sin cita, permitiendo la priorización en los casos preferentes. Al final de 2016 se realizó una nueva medición con la misma metodología. Para el análisis estadístico se han usado la t de Student y la Chi cuadrado. Resultados: En seis meses se redujo el número de pacientes sin cita de 4.726 a 0. El tiempo medio de espera en consultas externas pasó de 63 a 44,2 días. Los pacientes en espera de más de 50 días pasaron del 41,5% al 74,8%. El número de quejas y reclamaciones debidas a cita en consultas externas pasó de 161 a 80. Conclusiones: Ha mejorado la accesibilidad al disminuir el tiempo de espera media y se ha eliminado la lista de pacientes sin cita, si bien ha aumentado el número de pacientes pendientes de cita de más de 50 días. Se ha reducido a la mitad el número de quejas y reclamaciones

Background: The delay caused to provide an appointment and the uncertainty of the expected waiting time, are cause for discontent in the patients. The object of this work was to improve the accessibility to the consultation of specialized attention in our health area, decreasing the average waiting time and reduce the number of claims for this reason. Methods: To measure the quality of the service provided, 5 criteria were developed and evaluated, by means of a cross section, in December 2015 for all patients pending appointment in the Area. Likewise, the complaints and claims collected during the 6 months prior to this date were quantified. As an intervention, a new circuit was designed and implemented in the interconsultation process, protocolizing a direct and automatic citation system. This system also eliminated patients without an appointment, allowing prioritization in preferred cases. At the end of 2016, a new evaluation was made with the same methodology. For the statistical analysis, Student's t and Chi-square were used. Results: In six months the number of patients without appointment was reduced from 4726 to 0. The average waiting time for external consultations improved from 63 to 44.2 days. Patients waiting more than 50 days increased from 41.5% to 74.8%. The number of complaints and claims due to appointment in external consultations decreased from 161 to 80. Conclusions: Accessibility has improved by reducing the average waiting time and eliminating the list of patients without an appointment, although the number of patients pending appointments for more than 50 days has increased. The number of complaints and claims has been halved

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Los tumores hipofisarios secretores de tirotropina (tirotropinomas) son menos del 1% de los adenomas hipofisarios y una causa rara de hipertiroidismo. La mayoría se diagnostica como macroadenoma, y los microadenomas son excepcionales. Debe hacerse el diagnóstico diferencial con la resistencia a las hormonas tiroideas. El tratamiento de elección es la adenomectomía transesfenoidal. Si fracasa, los análogos de somatostatina son una alternativa terapéutica. Presentamos a una paciente con un microadenoma productor de tirotropina en quien se practicó una adenomectomía transesfenoidal. Tras el fracaso de la cirugía, se inició tratamiento con un análogo de somatostatina. En laactualidad, después de 9 años, la paciente continúa el tratamiento y el hipertiroidismo y el crecimiento tumoral están controlados (AU)

Thyrotropin secreting adenomas (TSHomas)account for less than 1% of all pituitary adenomas and are a rare cause of hyperthyroidism. Most cases correspond to macroadenomas, microadenomas beingexceptional. Differential diagnosis should be made with resistance to thyroid hormones. The first line treatment is transphenoidal surgery. When surgery is unsuccessful, somatostatin analogues are a therapeutic alternative. We report a patient with a TSH-secreting microadenoma. The microadenoma was resected through the transsphenoidal route. Because surgery was unsuccessful, medical therapy with somatostatin analogue was initiated. Currently, 9 years later, the patient continues to be under treatment with somatostatin analogue therapy, which has controlled the hyperthyroidism and tumoral growth. We describe successful long-term treatment of a TSH-oma with somatostatin analogue therapy when surgery is unsuccessful (AU)

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Thyrotropin secreting adenomas (TSH-omas) account for less than 1% of all pituitary adenomas and are a rare cause of hyperthyroidism. Most cases correspond to macroadenomas, microadenomas being exceptional. Differential diagnosis should be made with resistance to thyroid hormones. The first line treatment is transphenoidal surgery. When surgery is unsuccessful, somatostatin analogues are a therapeutic alternative. We report a patient with a TSH-secreting microadenoma. The microadenoma was resected through the transsphenoidal route. Because surgery was unsuccessful, medical therapy with somatostatin analogue was initiated. Currently, 9 years later, the patient continues to be under treatment with somatostatin analogue therapy, which has controlled the hyperthyroidism and tumoral growth. We describe successful long-term treatment of a TSH-oma with somatostatin analogue therapy when surgery is unsuccessful.