RESUMEN
Objetivo Conocer el coste económico a largo plazo asociado al tratamiento de la incontinencia fecal grave mediante SNS frente al tratamiento conservador sintomático y la colostomía definitiva. Métodos Estudio descriptivo pormenorizado de los costes del proceso asistencial (intervenciones, consultas, dispositivos, pruebas complementarias, hospitalización, etc.) de 3 alternativas de tratamiento de la incontinencia fecal empleando herramientas de gestión y contabilidad analítica del propio Servicio de Salud con base en datos de actividad clínica. Se estimó, en cada caso, la frecuencia de uso de recursos sanitarios o la cantidad de productos dispensados en farmacias (medicación, pañales, material de ostomía, etc.). Se incluyeron costes derivados de situaciones adversas. Se incluyeron pacientes con incontinencia fecal grave, definida por una puntación superior a 9 en la escala de severidad de Wexner, en los que han fracasado los tratamientos de primera línea. Se emplearon datos de una cohorte consecutiva de 93 pacientes a los que se realizó una SNS entre los años 2002 y 2016; de pacientes intervenidos de colostomía definitiva (n=2); hernia paraestomal (n=3) y estenosis de colostomía (n=1). Resultados El coste medio acumulado en 10 años por paciente en cada alternativa fue: 10.972,9 para el tratamiento sintomático (62% pañales); 17.351,57 para la SNS (95,83% intervenciones; 81,6% dispositivos), y 25.858,54 para la colostomía definitiva (70,4% material de ostomía) Conclusiones El manejo de la incontinencia fecal grave implica un gran impacto en términos económicos. La colostomía es la alternativa que más costes directos genera, seguida de la SNS y el tratamiento sintomático (AU)
Introduction Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy. Methods Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n=2); parastomal hernia (n=3), and colostomy stenosis (n=1). Results The mean cumulative cost in 10 years per patient in each alternative was: 10,972.9 symptomatic treatment (62% diapers); 17,351.57 SNS (95.83% interventions; 81.6% devices); 25,858.54 definitive colostomy (70.4% ostomy material and accessories). Conclusions Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment (AU)
Asunto(s)
Humanos , Incontinencia Fecal/economía , Incontinencia Fecal/terapia , Tratamiento Conservador/economía , Colostomía/economía , Costos de la Atención en Salud , Índice de Severidad de la Enfermedad , Análisis de Impacto Presupuestario de Avances TerapéuticosRESUMEN
Integration of electronic circuit components onto flexible materials such as plastic foils, paper and textiles is a key challenge for the development of future smart applications. Therefore, conductive metal features need to be deposited on temperature sensitive substrates in a fast and straightforward way. The feasibility of these emerging (nano-) electronic technologies depends on the availability of well-designed deposition techniques and on novel functional metal inks. As ultrasonic spray coating (USSC) is one of the most promising techniques to meet the above requirements, innovative metal organic decomposition (MOD) inks are designed to deposit silver features on plastic foils. Various amine ligands were screened and their influence on the ink stability and the characteristics of the resulting metal depositions were evaluated to determine the optimal formulation. Eventually, silver layers with excellent performance in terms of conductivity (15% bulk silver conductivity), stability, morphology and adhesion could be obtained, while operating in a very low temperature window of 70 °C-120 °C. Moreover, the optimal deposition conditions were determined via an in-depth analysis of the ultrasonically sprayed silver layers. Applying these tailored MOD inks, the USSC technique enabled smooth, semi-transparent silver layers with a tunable thickness on large areas without time-consuming additional sintering steps after deposition. Therefore, this novel combination of nanoparticle-free Ag-inks and the USSC process holds promise for high throughput deposition of highly conductive silver features on heat sensitive substrates and even 3D objects.
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Chest pain is the most common symptom of patients who present with ischemic heart disease. Morphine has traditionally been the drug of choice for managing chest pain in acute coronary syndrome (ACS) due to its high analgesic potency, though its physiological effects are poorly understood. Routinely used for managing chest pain, morphine is recommended in the 2002 guidelines of the American College of Cardiology/American Heart Association. This recommendation, however, is not based on a high level of scientific evidence but on expert opinion. Studies have found both for and against the use of morphine in ACS, suggesting that its benefits are perhaps not altogether clear. This review examines the pathophysiological effects of morphine and their cardiac implications, with special attention to a possible negative effect on ACS. We reviewed articles in the MEDLINE database from 1982 to 2006.
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Analgésicos Opioides/uso terapéutico , Angina de Pecho/tratamiento farmacológico , Morfina/uso terapéutico , Infarto del Miocardio/complicaciones , American Heart Association , Analgésicos Opioides/efectos adversos , Angina de Pecho/etiología , Cardiotónicos/uso terapéutico , Quimiotaxis de Leucocito/efectos de los fármacos , Ensayos Clínicos como Asunto/estadística & datos numéricos , Endotelinas/metabolismo , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiopatología , Humanos , Estructura Molecular , Morfina/efectos adversos , Morfina/química , Morfina/farmacología , Estudios Multicéntricos como Asunto/estadística & datos numéricos , Infarto del Miocardio/tratamiento farmacológico , Óxido Nítrico/metabolismo , Nitroglicerina/uso terapéutico , Guías de Práctica Clínica como Asunto , Receptores Opioides mu/agonistas , Receptores Opioides mu/fisiología , Estados Unidos , Factor A de Crecimiento Endotelial Vascular/fisiología , Vasodilatadores/uso terapéuticoRESUMEN
El dolor torácico es el síntoma más frecuente de presentación en pacientes con cardiopatía isquémica. Tradicionalmente la morfina ha sido el fármaco de elección para el control del dolor torácico en el síndrome coronario agudo (SCA) ya que su potencia analgésica es muy elevada, sin embargo sus efectos fisiológicos no están del todo claros. Su uso como terapéutica para el control del dolor torácico es de rutina, e incluso está incluida como recomendación en las guías de la ACC/AHA (American College of Cardiology/American Heart Association) delaño 2002, aunque esta recomendación no está basada enestudios científicos sólidos, sino en la opinión de expertos de la práctica clínica. La presencia de estudios a favor y en contra del uso de la morfina en el SCA, hacen ver que tal vez su beneficio no esté del todo claro. El objetivo de este trabajo es revisar los efectos fisiopatológicos de la morfina y sus implicaciones a nivel cardiaco, alertando de un posible efecto deletéreo en el SCA. Revisamos artículos desde el año 1982 al 2006 incluidos en la base de datos MEDLINE
Chest pain is the most common symptom of patientswho present with ischemic heart disease. Morphine hastraditionally been the drug of choice for managing chestpain in acute coronary syndrome (ACS) due to its highanalgesic potency, though its physiological effects arepoorly understood. Routinely used for managing chestpain, morphine is recommended in the 2002 guidelinesof the American College of Cardiology/American HeartAssociation. This recommendation, however, is not basedon a high level of scientific evidence but on expertopinion. Studies have found both for and against the useof morphine in ACS, suggesting that its benefits are perhaps not altogether clear. This review examines the pathophysiological effects of morphine and their cardiacimplications, with special attention to a possible negative effect on ACS. We reviewed articles in the MEDLINE database from 1982 to 2006
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Humanos , Infarto del Miocardio/tratamiento farmacológico , Analgesia/métodos , Morfina/farmacocinética , Dolor en el Pecho/tratamiento farmacológico , Cardiotónicos/farmacocinética , Técnicas Electrofisiológicas CardíacasAsunto(s)
Síndrome del Cromosoma X Frágil/genética , Síndrome de Rett/genética , Fragilidad Cromosómica , Familia , Femenino , Síndrome del Cromosoma X Frágil/diagnóstico , Síndrome del Cromosoma X Frágil/epidemiología , Pruebas Genéticas , Humanos , Masculino , Puerto Rico/epidemiología , Síndrome de Rett/diagnóstico , Síndrome de Rett/epidemiologíaRESUMEN
We present a patient with cutaneous mucinosis of the mammary areolae who developed multiple erythematous macules with clearly defined, geographical edges 1 year after diagnosis. These lesions demonstrated mycosis fungoides on histology. We discuss a possible association between the mucinosis and the mycosis fungoides.
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Mucinosis/complicaciones , Micosis Fungoide/complicaciones , Pezones , Neoplasias Cutáneas/complicaciones , Adulto , Enfermedades de la Mama/complicaciones , Enfermedades de la Mama/patología , Femenino , Humanos , Pezones/patologíaRESUMEN
We report our experience in the diagnosis, evaluation and counseling for the Marfan Syndrome in 35 individuals of 23 families. Utilizing the new clinical and diagnostic criteria, we observed that the frequency of the systems affected corresponds to those found in the literature. Presymptomatic treatment is possible, and considering the family history in the diagnosis is needed for adequate genetic counseling and the well-being of the affected patient
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Humanos , Masculino , Femenino , Síndrome de Marfan , Asesoramiento Genético , Síndrome de Marfan/complicaciones , Síndrome de Marfan/genéticaRESUMEN
We report our experience in the diagnosis, evaluation and counseling for the Marfan Syndrome in 35 individuals of 23 families. Utilizing the new clinical and diagnostic criteria, we observed that the frequency of the systems affected corresponds to those found in the literature. Presymptomatic treatment is possible, and considering the family history in the diagnosis is needed for adequate genetic counseling and the well-being of the affected patient.
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Síndrome de Marfan , Femenino , Asesoramiento Genético , Humanos , Masculino , Síndrome de Marfan/complicaciones , Síndrome de Marfan/genéticaRESUMEN
We report a heart transplant recipient who developed graft-versus-host disease (GVHD) following blood transfusion. We consider that heart transplant recipients should be included in the category of immunosuppressed patients who may develop this disease after being treated with blood products. We also consider that, at the present time, irradiation of blood products is the only useful method of avoiding development of GVHD in these patients.
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Enfermedad Injerto contra Huésped/etiología , Trasplante de Corazón , Complicaciones Posoperatorias , Reacción a la Transfusión , Femenino , Enfermedad Injerto contra Huésped/patología , Humanos , Terapia de Inmunosupresión , Persona de Mediana Edad , Factores de TiempoAsunto(s)
Edema/patología , Hemorragia/patología , Enfermedades de la Piel/patología , Enfermedad Aguda , Femenino , Humanos , LactanteRESUMEN
The appearance of metastasis without clinically demonstrable primary tumor is one of melanoma's challenges. The aim of this study was to recognize the specific characteristics of this occurrence. Based on our study of three patients, we have proposed theories to explain this behavior, its clinical approach, and therapeutic management. We conclude by stressing the importance of finding the primary tumor or traces of it.
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Melanoma/secundario , Neoplasias Primarias Desconocidas , Adulto , Anciano , Neoplasias Gingivales/patología , Neoplasias Gingivales/secundario , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/secundario , Humanos , Metástasis Linfática/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Neoplasias Primarias Desconocidas/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/secundarioAsunto(s)
Trasplante de Corazón , Tiña , Anciano , Dermatosis de la Mano/etiología , Humanos , MasculinoRESUMEN
Two unrelated females with the syndrome of distichiasis-lymphedema are presented. In both families, the autosomal dominant nature of the syndrome was evident, with multiple affected males and females. In the prepubertal period this disease may be confused with Turner or Noonan syndromes. Genetic counseling is important for this is a very crippling disease and an erroneous diagnosis of future sterility may be given to affected females. Ptosis, pterygium colli, lymphedema, cleft palate and a low posterior hairline can confuse the phenotype. A history of corneal irritation, photophobia and a need to self-pluck eyelashes may be the clue to the diagnosis. Close follow-up for associated complications, counseling and support to these families may be our contributions as clinicians in ameliorating the burden this disease brings.
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Anomalías Múltiples/diagnóstico , Pestañas/anomalías , Linfedema/diagnóstico , Síndrome de Turner/diagnóstico , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Fenotipo , SíndromeRESUMEN
Se presentan dos familias diferentes con el síndrome Distiquiasis-Linfedema. En ambas era evidente la herencia autosómica dominante del síndrome, con múltiples varones y hembras afectadas. Esta condición puede confundirse con los síndromes Turner y Noonan en el período prepuberal. La Consejería Genética es importante ya que la enfermedad es muy incapacitante y erróneamente puede ofrecerse un diagnóstico futuro de esterilidad a las hembras afectadas. Ptosis, pterigio colli, linfedema, paladar hendido y una inserción baja del cabello en la nuca confunden el fenotipo. Una historia anterior de irritación de la córnea, fotofobia, y la necesidad de estraer las pestañas puede ser clave del diagnóstico. Es necesario un seguimiento cercano para detectar las complicaciones asociadas. Consejería y ayuda a estas familias es nuestra contribución como clínicos para disminuir la carga que esta enfermedad conlleva
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Humanos , Femenino , Adolescente , Anomalías Múltiples/diagnóstico , Pestañas/anomalías , Linfedema/diagnóstico , Síndrome de Turner/diagnóstico , Diagnóstico Diferencial , Fenotipo , SíndromeRESUMEN
We have diagnosed and followed four Puerto Rican females with Rett Syndrome (RS). Their ages, when first examined, ranged from 10 months to 11 years. The classical symptoms of decreasing head size, onset of hand wringing movements with deterioration of milestones as well as EEG abnormalities were present in all. Case No. 1, considered our index case was evaluated by us and lost to follow-up for many years while residing in the mainland U.S.A. where multiple evaluations failed to give a definite diagnosis. Upon her return to Puerto Rico she was diagnosed by us in retrospect as having RS. These are the first Puerto Rican girls reported with RS and in doing so we hope for a better understanding of the syndrome by our medical community. Because of the devastating effects of RS, early diagnosis and parental counseling will be beneficial for patients and their families.