RESUMEN
OBJECTIVE: Pituitary adenomas (PA) are rare in young patients, and additional studies are needed to fully understand their pathogenesis in this population. We describe the clinical and genetic characteristics of apparently sporadic PA in a cohort of young patients. DESIGN: Clinical and molecular analysis of 235 patients (age ≤ 30 years) with PA. Clinicians from several Spanish and Chilean hospitals provided data. METHODS: Genetic screening was performed via next-generation sequencing and comparative genomic hybridization array. Clinical variables were compared among paediatric, adolescent (<19 years) and young adults' (≥19-30 years) cohorts and types of adenomas. Phenotype-genotype associations were examined. RESULTS: Among the total cohort, mean age was 17.3 years. Local mass effect symptoms were present in 22.0%, and prolactinomas were the most frequent (44.7%). Disease-causing germline variants were identified in 22 individuals (9.3%), more exactly in 13.1 and 4.7% of the populations aged between 0-19 and 19-30 years, respectively; genetically positive patients were younger at diagnosis and had larger tumour size. Healthy family carriers were also identified. CONCLUSIONS: Variants in genes associated with syndromic forms of PAs were detected in a large cohort of apparently sporadic pituitary tumours. We have identified novel variants in well-known genes and set the possibility of incomplete disease penetrance in carriers of MEN1 alterations or a limited clinical expression of the syndrome. Despite the low penetrance observed, screening of AIP and MEN1 variants in young patients and relatives is of clinical value.
Asunto(s)
Adenoma , Neoplasias Hipofisarias , Adenoma/diagnóstico , Adenoma/epidemiología , Adenoma/genética , Adolescente , Adulto , Edad de Inicio , Niño , Preescolar , Chile/epidemiología , Estudios de Cohortes , Femenino , Frecuencia de los Genes , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Mutación de Línea Germinal , Humanos , Lactante , Recién Nacido , Pérdida de Heterocigocidad , Masculino , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/epidemiología , Neoplasias Hipofisarias/genética , España/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: The requirement of the anesthesiologist for patient care outside the surgical area is constantly increasing. It is an activity that encompasses the different degrees of monitoring, sedation, and anesthesia. OBJECTIVE: To compare the safety and efficacy of midazolam midazolam-diphenhydramine against magnetic resonance with level of sedation on the Ramsay scale. MATERIALS AND METHODS: We performed a study in the Instituto Mexicano del Seguro Social Obregon, Sonora, of patients scheduled for cranial magnetic resonance imaging with sedation, during October and December 2013, comparing two groups: midazolam/diphenhydramine against midazolam groups. RESULTS: We included 68 patients, 34 in the experimental group (midazolam-diphenhydramine) versus 34 controls (midazolam). The Ramsay scale showed, in the experimental group, an increased sedation effect resulting in one Ramsay 1, at 10 minutes 2.8 2.8 20 minutes and 30 minutes 2.0. In the control group the basal Ramsay was 1, 2.1 to 10 minutes, 20 minutes and 2.1 to 2.0 at 30 minutes (p = 0.0001). The analysis of heart rate, respiratory, and baseline oxygen saturation, at 10, 20 and 30 minutes, was p = 0.0001 for both groups. CONCLUSION: The combination of diphenhydramine with intravenous midazolam is safe, with the degree of sedation being better compared with use of midazolam alone, resulting in less failure of sedation during magnetic resonance imaging.
Asunto(s)
Sedación Consciente , Difenhidramina/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Imagen por Resonancia Magnética , Midazolam/administración & dosificación , Adolescente , Adulto , Anciano , Combinación de Medicamentos , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS: Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN: Observational, descriptive study. METHODS: Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS: In 88% of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8%; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18%). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS: Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.
Asunto(s)
Diagnóstico , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales Públicos , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Servicio Ambulatorio en Hospital/economía , España , Adulto JovenRESUMEN
Background. In Mexico, a steady increase of patients with visceral leishmaniasis has been reported, especially in the states of Chiapas and Guerrero, yet only limited information exists on canine leishmaniasis in areas of visceral leishmaniasis in Mexico. A veterinary report of dogs with nonhealing cutaneous lesions in Pungarabato, Guerrero led us to investigate the possible presence of Leishmania infection in an area where Lutzomyia longipalpis and Lutzomyia evansi, both vectors of Leishmania infantum, have been described. Methods. We analyzed skin lesions of 25 dogs by immunohistochemistry and PCR. Results. We found a 60% prevalence of Leishmania-infected dogs, the infection rate being higher in males than females. Thus, we established a new focus of canine leishmaniasis, and although to date no patients have been reported in this municipality, it is close to and shares the same ecological characteristics of dry tropical forests as regions where visceral leishmaniasis has been reported in Mexico. We also include updated information of localities of visceral leishmaniasis in Mexico as well as the distribution of possible sand fly vectors. Conclusions. Our data show the need to ascertain the magnitude of this new focus in view of the current data on human visceral leishmaniasis, a disease that is surging in Mexico.
RESUMEN
BACKGROUND: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS: Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN: Observational, descriptive study. METHODS: Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS: In 88 percent of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8 percent; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18 percent). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS: Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Diagnóstico , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Hospitales Públicos , Hospitales Universitarios , Servicio Ambulatorio en Hospital/economía , EspañaRESUMEN
Introducción: Durante un año, en forma prospectiva, se utilizó la cefoxitina como monoterapia profiláctica en pacientes con trauma abdominal. Material y métodos: La dosis utilizada fue el doble de lo convencional en un esquema de corta duración desde una sola dosis hasta un máximo de cinco días, según se clasificó cada caso en un protocolo especial. Resultados: El 22 por ciento de los pacientes se infectaron y de ellos la mayoría fueron infecciones de herida operatoria. No hubo efectos tóxicos al medicamento, a diferencia de los esquemas utilizados anteriormente. Con dichos esquemas se encontró 39 por ciento de infecciones en 1995 y 76 por ciento en 1977, además de las complicaciones siguientes: ototoxicidad (sordera y síndrome vertiginoso); asi mismo un creciente aunque no determinado número de casos de insuficiencia renal aguda, la mayoría de ellos reversible. Conclusiones: la experiencia encontrada y lo que la literatura tiende a mostrar es que la profilaxis antimicriobiana en el trauma de abdomen es útil y el uso de antibióticos poco tóxicos, de amplio espectro, a grandes dosis en monoterapia y en esquemas de corta duración ofrece los mejores resultados clínicos y económicos
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos Abdominales , Cefoxitina , Infección de la Herida QuirúrgicaRESUMEN
Las hernias diafragmáticas postraumáticas crónicas representan una patología poco común en el paciente con trauma, pero con una significativa morbimortalidad en ausencia de diagnóstico y tratamiento oportunos. De junio 1996 a noviembre 1998, en el Hospital General de Accidentes del Instituto Guatemalteco de Seguridad Social, se presentaron 13 pacientes con hernia diafragmática postraumática, de las cuales 6 fueron operados inmediatamente por indicaciones de cirugía abdominal de urgencia. Los 7 restantes fueron operados tardíamente y constituyen la serie estudiada. Setenta y uno por ciento de los pacientes tenían antecedentes de trauma penetrante toracoabdominal de 30 días de evolución en promedio. Los casos restantes habían sufrido trauma cerrado de tórax de 2 años de evolución en promedio. Cuarenta y tres por ciento de los pacientes presentaban alguna sintomatología, siendo la más frecuente dolor torácido, el grupo restante se encontraban asintomáticos. El diagnóstico radiológico de hernia diafragmática se hizo sólo en dos de los casos. Todos los pacientes que sufrieron trauma penetrante (5/7) fueron resueltos por vía toracoscópica, y los dos casos de trauma cerrado fueron resueltos mediante toracotomía debido a que el defecto herniario se consideró grande. El órgano más frecuentemente herniado fue el epiplón en 6 casos. Los pacientes tuvieron una evolución adecuada, solamente se tuvo una complicación menor que se resolvió con tratamiento médico. Se concluye que la toracoscopía es una opción segura en el tratamiento de hernias diafragmáticas secundarias a trauma penetrante,mientras que las hernias secundarias a trauma cerrado deben ser abordadas por medio de toracotomía
Asunto(s)
Humanos , Hernia Diafragmática Traumática/cirugía , Toracoscopía , ToracotomíaRESUMEN
En el presente trabajo de investigación, se plantea un estudio de la condición periodontal en pacientes restaurados con prótesis parcial fija durante 1997 en las clínicas de la Facultad de Odontología de la Universidad de El Salvador que se realizó en el período de septiembre a noviembre de 1998. El documento comprende el desarrollo y los resultados de dicha investigación, en la cual se evaluaron cuales fueron las condiciones en que se encontraban las restauraciones y se detalla someramente, los efectos que éstas estaban causando en los tejidos periodontales. Para ello el estudio está formado por los siguientes capítulos: El capítulo I, consta de la justificación, objetivos de la investigación, alcances y limitaciones, variables e indicadores, unidades de análisis, objeto de transformación y la definición de términos básicos. El segundo capítulo, contiene el marco de referencia, que se divide en antecedentes y la discusión bibliográfica. En el tercer capítulo, se presenta la metodología de la investigación; la cual consta, del tipo de investigación, población, muestra y submuestra, selección de los objetos a quienes se les aplicarán los instrumentos, técnicas e instrumentos, elaboración y descripción de los instrumentos, procedimiento a utilizar para la recolección de los datos, problemas encontrados durante la recolección de los datos, procedimiento a utilizar para la tabulación de los datos, revisión y preparación de los instrumentos, descripción de las hojas tabulares, proceso de vaciado de los mismos y el método a utilizar para el análisis de los datos. El cuarto capítulo, está constituido por los resultados de la investigación; lo cual consta de cuadros estadísticos y descripción de los datos; análisis general de la problemática con base en los resultados de la investigación; a su vez se plantean las conclusiones especificas y generales, recomendaciones con base a los datos obtenidos, también se presentan los anexos y las fuentes bibliográficas consultadas para la investigación. Se espera que el trabajo, aporte a la Facultad de Odontología información referente al tema.
In this research work, a study of the periodontal condition in patients restored with a fixed partial denture during 1997 is proposed in the clinics of the Faculty of Dentistry of the University of El Salvador, which was carried out in the period from September to November 1998 The document includes the development and results of said research, in which the conditions in which the restorations were found were evaluated and the effects that these were causing on the periodontal tissues were briefly detailed. For this, the study consists of the following chapters: Chapter I, consists of the justification, research objectives, scope and limitations, variables and indicators, units of analysis, object of transformation and the definition of basic terms. The second chapter contains the frame of reference, which is divided into antecedents and bibliographic discussion. In the third chapter, the research methodology is presented; which consists of the type of research, population, sample and subsample, selection of the objects to which the instruments, techniques and instruments will be applied, preparation and description of the instruments, procedure to be used for data collection, problems encountered during data collection, procedure to be used for data tabulation, review and preparation of instruments, description of tabular sheets, process of emptying them and the method to be used for data analysis. The fourth chapter is made up of the results of the investigation; which consists of statistical tables and description of the data; general analysis of the problem based on the results of the investigation; At the same time, the specific and general conclusions, recommendations based on the data obtained, are also presented, the annexes and the bibliographic sources consulted for the research are also presented. The work is expected to provide the Faculty of Dentistry with information on the subject.