Exploring healthcare barriers and satisfaction levels among deaf individuals in Ecuador: A video-based survey approach.

BACKGROUND: Approximately 80% of Deaf individuals live in low- and middle-income countries, where health systems often overlook their specific needs. This communication gap can result in misdiagnosis and inappropriate treatment, impacting their overall satisfaction with healthcare services. OBJECTIVES: This study aims to uncover barriers to healthcare access and preferences among the Deaf population in Ecuador, and the role of communication barriers in shaping satisfaction levels with healthcare services. METHODS: The study gathered data from 386 participants through online surveys, focusing on demographic characteristics, healthcare experiences, communication methods, and levels of satisfaction. Descriptive statistics and association analyses were employed to analyze the data. RESULTS: The study reveals that nearly all participants possessed an officially recognized disability (95.9%) and 53.9% reported hereditary deafness. Ecuadorian sign language was predominant (60.9%). Communication barriers were evident, with 65.0% having trouble understanding medical instructions, and 66.6% identifying a deficiency of tools for Deaf individuals in healthcare settings. Satisfaction levels were associated with the presence of interpreters during medical care, with 46.6% expressing a preference for interpreters over other communication methods. Additionally, private healthcare facilities were perceived as providing better services, despite being less frequently accessed (38.9%). Dissatisfaction was evident, particularly in aspects of communication and physician courtesy. CONCLUSIONS: This study underscores the importance of tailoring healthcare services to address the unique needs of the Deaf population. Communication barriers emerged as a central obstacle, necessitating the inclusion of sign language interpreters and improvement of resources. The study's implications extend to healthcare equity in developing nations, emphasizing the significance of patient-centered care and inclusive healthcare practices.

How to 19F MRI: applications, technique, and getting started.

Magnetic resonance imaging (MRI) plays a significant role in the routine imaging workflow, providing both anatomical and functional information. 19F MRI is an evolving imaging modality where instead of 1H, 19F nuclei are excited. As the signal from endogenous 19F in the body is negligible, exogenous 19F signals obtained by 19F radiofrequency coils are exceptionally specific. Highly fluorinated agents targeting particular biological processes (i.e., the presence of immune cells) have been visualised using 19F MRI, highlighting its potential for non-invasive and longitudinal molecular imaging. This article aims to provide both a broad overview of the various applications of 19F MRI, with cancer imaging as a focus, as well as a practical guide to 19F imaging. We will discuss the essential elements of a 19F system and address common pitfalls during acquisition. Last but not least, we will highlight future perspectives that will enhance the role of this modality. While not an exhaustive exploration of all 19F literature, we endeavour to encapsulate the broad themes of the field and introduce the world of 19F molecular imaging to newcomers. 19F MRI bridges several domains, imaging, physics, chemistry, and biology, necessitating multidisciplinary teams to be able to harness this technology effectively. As further technical developments allow for greater sensitivity, we envision that 19F MRI can help unlock insight into biological processes non-invasively and longitudinally.

Efectividad de la hipnosis en cantidad y calidad del sueño en pacientes con depresión post-COVID / Effectiveness of hypnotherapy on sleep quality and quantity in patients with post-COVID depression

Introducción: Se conocen diversos tratamientos para tratar y curar la depresión. Entre los más utilizados se encuentran la psicoterapia y la medicación. La hipnosis clínica utiliza un discurso basado en la sugestión y en los reflejos condicionados del sueño, para lograr la estabilidad en la desregulación del ciclo sueño / vigilia, lo cual es un factor esencial en el tratamiento de las personas deprimidas por la COVID-19. Objetivo: Comparar la evolución en la calidad y cantidad de sueño en pacientes con depresión post-COVID que fueron tratados con medicación e hipnosis. Métodos: Se realizó un estudio explicativo-comparativo, y un diseño cuasi-experimental. La muestra fue de 40 pacientes que fueron ingresados en el Hospital Universitario Clínico Quirúrgico «Cmdte. Manuel Fajardo Rivero», de Santa Clara, entre enero y marzo de 2021, con COVID-19. En un grupo de pacientes se empleó el inventario de depresión de Beck y un cuestionario para evaluar la cantidad y calidad del sueño antes y después de la intervención con medicación; en el otro grupo se empleó la hipnosis. Se utilizó la estadística descriptiva. Resultados: En ambos grupos la terapia empleada fue efectiva, redujo los niveles de depresión y eliminó las alteraciones del sueño. Conclusiones: Ambas formas de tratamiento se pueden emplear para tratar la depresión y los desórdenes propios del sueño. El método sugestivo de despertar de sueño hipnótico a sueño natural fue tan efectivo como los psicofármacos empleados.

Introduction: various treatments are known to treat and cure depression. Psychotherapy and medication are among the most used. Clinical hypnosis uses a discourse based on suggestions and conditioned sleep reflexes to achieve stability in sleep-wake cycle dysregulation, which is an essential factor in the treatment of people depressed by COVID-19. Objective: to compare the evolution in sleep quality and quantity in patients with post-COVID depression who were treated with medication and hypnotherapy. Methods: an explanatory comparative study with a quasi-experimental design was carried out. The sample consisted of 40 patients who were admitted due to COVID-19 at "Cmdte. Manuel Fajardo Rivero" Clinical and Surgical University Hospital from Santa Clara between January and March 2021. Beck Depression Inventory and a questionnaire were used in a group of patients to assess the sleep quality and quantity before and after the intervention with medication; hypnosis was used in the other group. Descriptive statistics was also used. Results: the used therapy was effective in both groups, reduced levels of depression and eliminated sleep disturbances. Conclusions: both forms of treatment can be used to treat depression and sleep disorders. The suggestive method of awakening from hypnotic sleep to natural sleep was as effective as the psychoactive drugs used.

Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series.

BACKGROUND: Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. CASES PRESENTATION: From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). CONCLUSION: Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.

Acercamiento teórico al uso de la imagenología en el diagnóstico temprano de la artritis reumatoide / Theoretical approach to the use of imaging in the early diagnosis of rheumatoid arthritis

La artritis reumatoide es una enfermedad progresiva, con manifestaciones clásicas y tempranas como es la afectación de las articulaciones pequeñas de las manos y los tobillos. Se realizó una revisión bibliográfica de los documentos publicados entre 2017 y 2022. Se realizó una lectura preliminar de 37 artículos que cumplían con los criterios de inclusión, y finalmente se seleccionaron 23 artículos, de los cuales se tomó el contenido de mayor importancia. La ecografía es una técnica fiable y más sensible que la exploración clínica en el estudio de la enfermedad músculo-esquelética, pues permite una exploración multiplanar y dinámica, lo que resulta en un diagnóstico más exacto. La técnica Doppler constituye un complemento útil en el seguimiento de estos pacientes. Esta enfermedad es recurrente en las consultas de Reumatología, por tanto, en su valoración inicial, la utilidad de los medios diagnósticos, especialmente la ecografía, tiene gran importancia.

Rheumatoid arthritis is a progressive disease, with classic and early manifestations such as involvement of the small joints of the hands and ankles. We conducted a bibliographic review of the documents published between 2017 and 2022. A preliminary reading of 37 articles that met the inclusion criteria was carried out, and 23 articles were finally selected, from which the most important content was taken. Ultrasound is a more sensitive and reliable technique than clinical examination for the study of musculoskeletal disease, since it allows a multiplanar and dynamic examination, which results in a more accurate diagnosis. Doppler technique is a useful complement in the follow-up of these patients. This disease is recurrent in Rheumatology consultations, that's why in its initial assessment, the usefulness of diagnostic means, especially ultrasound, is of great importance.

Understanding medical mistrust and HPV vaccine hesitancy among multiethnic parents in Los Angeles.

Determinants of parental HPV vaccine hesitancy, including medical mistrust and exposure to negative vaccine information, are understudied in racial/ethnic minority communities where vaccine uptake is low. We conducted a cross-sectional survey (March 2021) among parents of adolescents, ages 9-17 years, from an academic enrichment program serving low-income, first-generation, underrepresented minority families in Los Angeles to understand determinants of parental HPV vaccine hesitancy. Parents completed self-administered surveys, including a 9-item HPV vaccine hesitancy scale, in either English, Spanish, or Chinese. Logistic regression was used to identify individual and interpersonal factors associated with parental hesitancy and adolescent HPV vaccination. One-fifth of parents (n = 357) reported high HPV vaccine hesitancy and > 50% reported concerns about safety or side effects. High medical mistrust was associated with high parental HPV vaccine hesitancy (adjusted-OR 1.69, 95% CI: 1.13, 2.37). Community-tailored and multilevel strategies to increase vaccine confidence are needed to improve HPV and other adolescent vaccinations.

Repair with a pulmonary neovalve in tetralogy of Fallot: does this avoid ventricular dysfunction?

OBJECTIVES: Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation. METHODS: Between January 2010 and July 2019, we performed 274 surgical corrections of tetralogy of Fallot at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a TAP in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a TAP without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analysed patient's characteristics before, during and after surgery at a 30-day follow-up. RESULTS: We found that patients in Group III were older (P = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, P = 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in Group I (P < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, P = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, P = 0.001). CONCLUSIONS: Preservation of the pulmonary valve is an important factor for immediate postoperative management of tetralogy of Fallot. Patients who were repaired with a TAP with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.

2640 Meters Closer to the Stars: Does High Altitude Affect Fontan Results?

BACKGROUND: Risk factors for and postoperative results of the Fontan operation in patients living at high altitude (>2500 meters above sea level) in the Andean region remain unknown. This study was conducted to evaluate immediate postoperative outcomes and to assess short- and long-term functional class after the Fontan operation. METHODS: From June 2003 to February 2019, 104 patients receiving the Fontan procedure at 2640 meters (8661 feet) above sea level were retrospectively studied. Preoperative catheterization, intraoperative variables, and postoperative outcomes were described. Functional class was evaluated in patients living permanently below (group I) and at or higher than 2500 meters (8202 feet) above sea level (group II). Risk factors for mortality were analyzed. RESULTS: Median age at operation was 8.5 ± 4.4 years; pulmonary artery pressure, 16.2 ± 3.6 mm Hg; end-diastolic systemic ventricular pressure, 13.3 ± 3.8 mm Hg; and pulmonary vascular resistance index, 2.1 (interquartile range, 07-3.7) Wood units. Chest tube duration was 8.5 (6-12) days. Mortality was 4.8%, with 0 in the last 5 years. Higher preoperative pulmonary pressure (16.2 ± 3.6 mm Hg vs 21.2 ± 3.40 mm Hg; P = .01), aortic cross-clamp time (P < .001), and renal failure (P < .01) were associated with mortality. Functional class improved to class I in 86.4%. Overall survival was 90.7% at 10 years of follow-up. CONCLUSIONS: Increased pulmonary pressure and pulmonary vascular resistance index are directly related to high altitude. The Fontan-Kreutzer operation performed at high altitude in the Andean region is feasible with good results. We routinely fenestrate all cases to avoid dysfunction in the early postoperative period. Functional status is adequate after the operation.

Riesgo cardiovascular en mujeres sanas

RESUMEN Introducción: Las enfermedades cardiovasculares son un problema de salud y una de las principales causas de muerte a nivel mundial. Presentan alta morbilidad y mortalidad en mujeres de entre 40 y 59 años, período que coincide con la menopausia natural. Objetivo: Caracterizar el riesgo cardiovascular en pacientes femeninas sanas. Métodos: Se realizó un estudio descriptivo, en 96 mujeres sanas. Fueron estudiadas variables epidemiológicas, clínicas, la valoración nutricional, circunferencia abdominal, estudios de laboratorio (triacilglicéridos, glucemia y colesterol total) y se realizó estratificación del riesgo cardiovascular. Se realizó un análisis de frecuencias y se empleó el test de ji cuadrado de Pearson para las comparaciones. Resultados: El grupo más representativo fue de 20 a 29 años de edad, los factores de riesgo con mayor incidencia fueron, la circunferencia abdominal por encima de 88 cm, IMC superior a 25 kg/m2, colesterol elevado e hipertrigliceridemia con asociación estadísticamente significativa (p< 0,000), predominaron las mujeres sin factores de riesgo en menores de 40 años, el bajo riesgo cardiovascular en todas las edades; el moderado y alto fue más significativo entre 40 y 49, y entre 50 y 59 años de edad (p< 0,000). Conclusiones: Predomina el bajo riesgo cardiovascular en mujeres menores de 40 años sin asociación de factores de riesgo; en las mayores de 40 predomina el moderado, con asociaciones entre factores de riesgo. El aumento del IMC, el colesterol elevado, la hipertrigliceridemia y la circunferencia abdominal mayor de 88 cm, fueron los factores de riesgo más importantes y estuvieron relacionados con la edad. Palabras clave: factores de riesgo; enfermedad cardiovascular; fisiología cardiovascular; identidad de género. ABSTRACT Introduction: Cardiovascular diseases are a health problem and one of the main causes of death worldwide. They present high morbidity and mortality in women between the ages of 40 and 59, a period that coincides with natural menopause. Objective: To characterize cardiovascular risk in healthy female patients. Methods: A descriptive study was carried out in 96 healthy women. Epidemiological and clinical variables, nutritional assessment, abdominal circumference, laboratory studies (triacylglycerides, glycemia and total cholesterol) were studied, and cardiovascular risk stratification was performed. A frequency analysis was performed and Pearson's chi-square test was used for comparisons. Results: The most representative group was 20 to 29 years old, the risk factors with the highest incidence were abdominal circumference above 88 cm, body mass index above 25 kg/m2, high cholesterol and hypertriglyceridemia with association statistically significant (p< 0.000), women without risk factors prevailed in those under 40 years of age, low cardiovascular risk in all ages; moderate and high was more significant between 40 and 49, and between 50 and 59 years of age (p< 0.000). Conclusions: Low cardiovascular risk predominates in women under 40 years of age without association of risk factors; in those over 40 the moderate predominates, with associations between risk factors. Increased BMI, high cholesterol, hypertriglyceridemia, and abdominal circumference greater than 88 cm were the most important risk factors and were related to age.

Improving cardiovascular magnetic resonance access in low- and middle-income countries for cardiomyopathy assessment: rapid cardiovascular magnetic resonance.

AIMS: To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). METHODS AND RESULTS: Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees-potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6 min (contrast) and 12 ± 4 min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1-2 days per week, 30 min slots). CONCLUSIONS: Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time.

Síntomas afectivos en profesionales que laboran en la atención a casos positivos de COVID-19 / Affective symptoms in professionals who work in the positive COVID-19 cases care

RESUMEN Fundamento La COVID-19 implica retos específicos para los trabajadores de la salud, los cuales representan una mayor carga de estrés. Ello confiere interés y relevancia al estudio de la esfera afectiva en este sector, protagonista en la atención a pacientes positivos de COVID-19. Objetivo caracterizar síntomas afectivos en profesionales que laboran en la atención a casos positivos de COVID-19. Métodos se realizó un estudio descriptivo transversal, en profesionales de la salud que laboran en la atención a pacientes positivos a la COVID-19; enmarcado entre los meses de abril y julio del 2020, en el hospital Manuel Fajardo Rivero de Santa Clara. La población de estudio fueron 82 trabajadores (enfermeros y tecnólogos de la Salud). Las variables estudiadas fueron sexo, categoría profesional y rango de severidad de los síntomas afectivos (depresión y ansiedad). Resultados la totalidad de los profesionales presentó algún grado de ansiedad, con predominio de la forma moderada (64,6 %). El 63,4 % no manifestó depresión, sin embargo, el 43,47 % de los que tuvieron este síntoma fueron mujeres, y el 52,63 % enfermeros de profesión. La ansiedad en forma moderada afectó al 72,22 % de los hombres, 58,69 % de las mujeres, y el 68,42 % de los enfermeros. Conclusión Entre los síntomas afectivos en profesionales que laboran en la atención de casos positivos a la COVID 19 se observó un predominio de la ansiedad. Este estudio explora aspectos de la salud mental que avizoran sobre la importancia de intervenciones futuras.

ABSTRACT Background COVID-19 involves specific challenges for healthcare workers, which represent a greater burden of stress. This confers interest and relevance to the study of the affective sphere in this sector, a protagonist in the positive COVID-19 patient's care. Objective to characterize affective symptoms in professionals who work in the positive COVID-19 cases care. Methods a cross-sectional descriptive study was carried out in health professionals who work in the positive COVID-19 patient's care; between April and July 2020, at the Manuel Fajardo Rivero hospital in Santa Clara. 82 workers (nurses and health technologists) were the study population. The variables studied were sex, professional category and range of severity of affective symptoms (depression and anxiety). Results all the professionals presented some degree of anxiety, with a predominance of the moderate form (64.6%). The 63.4% did not show depression, however, 43.47% of those who had this symptom were women, and 52.63% were professional nurses. Anxiety moderately affected 72.22% of men, 58.69% of women, and 68.42% of nurses. Conclusion Among the affective symptoms in professionals who work in the positive COVID 19 cases care, a predominance of anxiety was observed. This study explores aspects of mental health that foresee the importance of future interventions.

Síndrome neurológico maligno: a propósito de un caso / Malignant neurological syndrome: about a case

RESUMEN Fundamento: los neurolépticos con efecto antipsicótico, son eficaces para controlar los síntomas de la esquizofrenia, delirios y alucinaciones. El síndrome neuroléptico maligno es el efecto adverso más grave ocasionado por los antipsicóticos. Objetivo: presentar un caso inusual de un paciente con diagnóstico de cuadro psicótico que presentó un síndrome neuroléptico maligno ocasionado por los antipsicóticos. Presentación del caso: se ingresa un paciente que escucha voces dentro de su cabeza y el médico lo nota hiperconcentrado además realizaba movimientos estereotipados con dificultades para deambular. Al septimo día de hospitalización comienza con rigidez generalizada, temblor, trastornos del lenguaje y disfagia que se interpreta como un síndrome extrapiramidal de causa medicamentosa, con cifras de creatininfosfoquinasa aumentadas. Se emplea la bromocriptina 2,5 mg cada 12 horas, además de hidratación enérgica, anticoagulación profiláctica con heparina de bajo peso molecular y evaluación periódica de la función respiratoria y renal. Conclusiones: el síndrome neurológico maligno corresponde a una reacción de tipo idiosincrático, producida por cualquier fármaco bloqueador del receptor de la dopamina asociada clásicamente a los fármacos antipsicóticos de alta potencia como haloperidol y flufenazina, como se observó en el caso, por lo que fue necesario identificar los signos prodrómicos de forma precoz y realizar las modificaciones terapéuticas de forma oportuna a fin de prevenir el cuadro grave y restablecer la salud del enfermo con mínimo riesgo.

ABSTRACT Background: neuroleptics with an antipsychotic effect are effective in controlling the symptoms of schizophrenia, delusions and hallucinations. Neuroleptic malignant syndrome is the most serious adverse effect caused by antipsychotics. Objective: to present an unusual case of a patient with a diagnosis of psychotic symptoms who presented a neuroleptic malignant syndrome caused by antipsychotics. Case report: a patient who listens to voices inside his head is admitted and the doctor notes that he was hyperconcentrated and performed stereotyped movements with difficulties in wandering. At the 7th day of hospitalization he begins with generalized rigidity, tremor, language disorders and dysphagia that is interpreted as an extrapyramidal syndrome of drug cause, with increased creatinine phosphokinase (CK) levels. Bromocriptine 2.5 mg every 12 hours is used, in addition to vigorous hydration, prophylactic anticoagulation with low molecular weight heparin and periodic assessment of respiratory and renal function. Conclusions: the malignant neurological syndrome corresponds to an idiosyncratic reaction, produced by any dopamine receptor blocker drug classically associated with high potency antipsychotic drugs such as haloperidol and fluphenazine, as observed in the case presented in the article, so it was necessary to identify the prodromal signs early and make the therapeutic changes in a timely manner in order to prevent the serious condition and restore the health of the patient with minimal risk.

Interventions to increase the pharmacological adherence on arterial hypertension in Latin America: a systematic review.

OBJECTIVES: This review aims to summarize evidence on the effectiveness of interventions to improve antihypertensive drug adherence in Latin America and the Caribbean. METHODS: A systematic search from January 2000 to October 2018 was conducted through LILACS, SciELO, MEDLINE, Health Evidence, Cochrane Library and Embase. Search terms were in English, Portuguese and Spanish through the MeSH and DECS. RESULTS: Seven articles were included in the study. The main discoveries indicate that implemented interventions to increase the adherence are very varied. Likewise, a high variability in levels of adherence was found (46-94%) and we could evidence that indirect measurements were used. Lastly, it was evidenced that the obstacles for adherence were mainly associated with the adverse effects of antihypertensive medication, the dosage and forgetfulness of the medication intake given the age of the patients. CONCLUSIONS: There is no single strategy to increase pharmacological adherence in Latin America since the studies used different strategies. Additional efforts are required to standardize cost-effective interventions to increase pharmacological adherence in Latin America.

Attributed costs of health care-associated infections in a Colombian hospital, 2011- 2015 / Costos atribuidos a las infecciones asociadas con la atención en salud en un hospital de Colombia, 2011-2015

Introduction: The cost analysis of infections associated with health care represents a challenge for the health system in Colombia given their determinants. Objective: To determine the factors related to the increase and variability in the costs of hospital care for infections associated with health care in a fourth-level hospital in Bogotá from 2011 to 2015. Materials and methods: The costs of the care for 292 patients were analyzed including each of the activities carried out since the suspicion of the infectious disease until its resolution. These costs were standardized to the value of the Instituto de Seguros Sociales tariff manual adjusted by the annual consumer price index for health until 2014. The factors related to the increase in management costs were identified using a conditional logistic regression model. Results: A hospital stay of nine days or more prior to the infection was a factor associated with the increase of direct costs in the management of infections associated with health care (OR=2.06; 95% CI: 1.11-3.63). The median cost of the infections was COP $1.190.879. The antibiotic treatment represented 41% of the total value of the treatment, followed by laboratory tests with a cost equivalent to 13.5%. Conclusions: We found a relationship between the cost of the management of infections associated with health care and the hospital stay prior to their appearance. The pathological antecedents of the patients were not related to the increase in the cost.

Introducción. El análisis de los costos derivados de las infecciones asociadas con la atención en salud representa un desafío para el sistema de salud en Colombia dados sus factores determinantes. Objetivo. Determinar los factores relacionados con el aumento y la variabilidad de los costos de la atención hospitalaria por las infecciones asociadas con la atención en salud en un hospital de cuarto nivel de Bogotá, entre el 2011 y el 2015. Materiales y métodos. Se analizaron los costos de la atención de 292 pacientes, los cuales se estimaron para cada una de las actividades realizadas desde el momento de sospechar el cuadro infeccioso hasta su resolución. Dichos costos se estandarizaron según el valor del manual tarifario del Instituto de Seguros Sociales, ajustándolos por el índice de precios al consumidor para salud hasta el año 2014. Se determinaron los factores relacionados con el aumento del costo del manejo mediante un modelo logístico condicional. Resultados. La estancia hospitalaria de nueve días o más antes de la infección, se asoció con el aumento del costo directo del manejo de las infecciones relacionadas con la atención en salud (odds ratio, OR=2,06; IC95% 1,11-3,63). El costo medio del manejo de las infecciones fue de COP $1.190.879. Los antibióticos representaron el 41 % del valor total del tratamiento, seguidos de los exámenes de laboratorio, con un costo equivalente al 13,5 %. Conclusión. Se encontró una relación entre el costo del manejo de las infecciones asociadas con la atención en salud y la estancia hospitalaria previa a su aparición. Los antecedentes patológicos de los pacientes no se relacionaron con el aumento de los costos.

Aporte de la medicina basada en la evidencia al ejercicio profesional / Contribution of evidence-based medicine to professional practice

La medicina basada en la evidencia nace como paradigma a la práctica previa de la medicina que tenía como pilares el razonamiento fisiopatológico de la enfermedad y la experiencia del médico. Con el objetivo de actualizar los conocimientos de la medicina basada en la evidencia en relación con el método clínico, se realizó una revisión bibliográfica descriptiva de 29 artículos relacionados con el tema. Se referenciaron 13 artículos de los últimos cinco años publicados en revistas de los grupos 1 y 2, empleando las bases de datos SciELO, Medline, Pubmed e Hinari y Google Académico. Se concluyó que la medicina basada en la evidencia parte de evaluar críticamente la literatura científica, de modo que se pueda extrapolar los resultados investigativos en la construcción del conocimiento, es decir, acortar la brecha entre la investigación y la práctica clínica(AU)

Evidence-based medicine arose as a paradigm to the previous practice of medicine that had the pathophysiological reasoning of the disease and the doctor's experience as pillars. In order to update the knowledge of evidence-based medicine in relation to the clinical method, a descriptive bibliographic review of 29 articles related to the subject was carried out. 13 articles published in the last five years in journals of groups 1 and 2 were referenced, using SciELO, Medline, Pubmed, Hinari and Google Scholar databases. It was concluded that evidence-based medicine starts from critically evaluating scientific literature, so that research results can be reasoned in the construction of knowledge, that is, shortening the gap between research and clinical practice(AU)

Costos atribuidos a las infecciones asociadas con la atención en salud en un hospital de Colombia, 2011-2015 / Attributed costs of health care-associated infections in a Colombian hospital, 2011- 2015

Resumen Introducción. El análisis de los costos derivados de las infecciones asociadas con la atención en salud representa un desafío para el sistema de salud en Colombia dados sus factores determinantes. Objetivo. Determinar los factores relacionados con el aumento y la variabilidad de los costos de la atención hospitalaria por las infecciones asociadas con la atención en salud en un hospital de cuarto nivel de Bogotá, entre el 2011 y el 2015. Materiales y métodos. Se analizaron los costos de la atención de 292 pacientes, los cuales se estimaron para cada una de las actividades realizadas desde el momento de sospechar el cuadro infeccioso hasta su resolución. Dichos costos se estandarizaron según el valor del manual tarifario del Instituto de Seguros Sociales, ajustándolos por el índice de precios al consumidor para salud hasta el año 2014. Se determinaron los factores relacionados con el aumento del costo del manejo mediante un modelo logístico condicional. Resultados. La estancia hospitalaria de nueve días o más antes de la infección, se asoció con el aumento del costo directo del manejo de las infecciones relacionadas con la atención en salud (odds ratio, OR=2,06; IC95% 1,11-3,63). El costo medio del manejo de las infecciones fue de COP $1.190.879. Los antibióticos representaron el 41 % del valor total del tratamiento, seguidos de los exámenes de laboratorio, con un costo equivalente al 13,5 %. Conclusión. Se encontró una relación entre el costo del manejo de las infecciones asociadas con la atención en salud y la estancia hospitalaria previa a su aparición. Los antecedentes patológicos de los pacientes no se relacionaron con el aumento de los costos.

Abstract Introduction: The cost analysis of infections associated with health care represents a challenge for the health system in Colombia given their determinants. Objective: To determine the factors related to the increase and variability in the costs of hospital care for infections associated with health care in a fourth-level hospital in Bogotá from 2011 to 2015. Materials and methods: The costs of the care for 292 patients were analyzed including each of the activities carried out since the suspicion of the infectious disease until its resolution. These costs were standardized to the value of the Instituto de Seguros Sociales tariff manual adjusted by the annual consumer price index for health until 2014. The factors related to the increase in management costs were identified using a conditional logistic regression model. Results: A hospital stay of nine days or more prior to the infection was a factor associated with the increase of direct costs in the management of infections associated with health care (OR=2.06; 95% CI: 1.11-3.63). The median cost of the infections was COP $1.190.879. The antibiotic treatment represented 41% of the total value of the treatment, followed by laboratory tests with a cost equivalent to 13.5%. Conclusions: We found a relationship between the cost of the management of infections associated with health care and the hospital stay prior to their appearance. The pathological antecedents of the patients were not related to the increase in the cost.

Determinantes económicos en la incidencia de tuberculosis en México / Economic determinants in the incidence of tuberculosis in Mexico

Resumen Introducción La tuberculosis es la causa principal de muerte por un solo agente infeccioso en el mundo. Anualmente, ocurren 10 millones de casos nuevos y más del 95% en países en vías de desarrollo; este problema de salud se vincula a las condiciones sociales y económicas de la población. Objetivo Analizar la relación entre el gasto en salud y la pobreza con la incidencia de tuberculosis en México. Material y métodos Investigación no experimental en el que se analizan reportes económicos y epidemiológicos de tuberculosis de México, periodo 2009-2015. Resultados El producto interno bruto (PIB) de México creció 45% en 2014 con relación al año 2009. El porcentaje del PIB invertido en salud disminuyó desde 2009, pasando de 6.2 a 5.9% en 2015. La población en pobreza aumentó de 2010 a 2014, de 46.1 a 46.2%; la pobreza extrema disminuyó de 11.3 a 9.5%. En 2015, se diagnosticaron 20,561 casos nuevos de tuberculosis, con una incidencia de 17 casos por cada 100,000 habitantes, incrementando dos décimas con relación al año previo. Conclusión El incremento de la incidencia de tuberculosis en México se relaciona con las condiciones socioeconómicas de la población. Las políticas públicas deberán atender los determinantes sociales.

Abstract Introduction Tuberculosis, the main cause of death by a single infectious agent in the world. Annually there are 10 million new cases and more than 95% in developing countries; this health problem is linked to the social and economic conditions of the population. Objective To analyze the relationship between health spending and poverty with the incidence of tuberculosis in Mexico. Material and methods Non-experimental research, analyzing economic and epidemiological reports of tuberculosis in Mexico, period 2009-2015. Results Mexico's Gross Domestic Product (GDP) grew 45% in 2014 compared to 2009. The percentage of GDP invested in health decreased since 2009, from 6.2 to 5.9% in 2015. The population in poverty increased from 2010 to 2014, from 46.1 to 46.2%; extreme poverty decreased from 11.3 to 9.5%. In 2015, 20,561 new cases of tuberculosis were diagnosed, with an incidence of 17 cases per 100,000 inhabitants, increasing two tenths in relation to the previous year. Conclusion The increase in the incidence of tuberculosis in Mexico is related to the socioeconomic conditions of the population. Public policies must address social determinants.

Dermatosis en pacientes trasplantados renales / Dermatoses in renal transplant recipients

Introducción: los pacientes trasplantados renales se encuentran en una situación de inmunosupresión crónica que favorece la aparición de lesiones dermatológicas. El equipo multidisciplinario tratante debe conocer estas enfermedades para orientar el tratamiento oportuno. Objetivo: determinar la prevalencia de lesiones dermatológicas en la población adulta con antecedente de trasplante renal, atendida en consulta externa del Hospital de San José de Bogotá, Colombia, entre julio del 2015 y julio del 2016. Materiales y métodos: estudio descriptivo de corte transversal en 33 pacientes adultos con antecedente de trasplante renal. Resultados: edad promedio de 49,7 an˜ os (DE 11,6), 23 fueron mujeres (69,7%), con el tiempo mediano de trasplante de 4 an˜ os (RIQ p25: 2 an˜ os-p: 75:7 an˜ os). Todos se encontraban en fase de mantenimiento. La prevalencia de lesiones dermatológicas fue de 81,8% (n = 27); predominaron las de tipo inflamatorio y otras (51,5%), seguidas de las infecciosas (33,3%). Se identificaron 3 sospechosas de neoplasia (9,0%), confirmando por biopsia 2 carcinomas basocelulares (n = 2) y un carcinoma escamocelular infiltrante (n = 1). Conclusión: en pacientes trasplantados renales la frecuencia de lesiones dermatológicas es alta. El disen˜ o no permite establecer relación de causalidad entre la terapia inmunosupresora y su aparición. Se resalta la necesidad de un examen dermatológico periódico para detectar enfermedades de piel, mucosas y anexos, que afectan a la calidad de vida.

Introduction: The chronic use of immunosuppressive therapy in renal transplant recipients (RTRs) favors the appearance of cutaneous lesions. Members of the multidisciplinary team should have knowledge of these diseases in order for them to be able to provide timely treatment. Objective: To determine the prevalence of cutaneous diseases among adult RTRs seen in the outpatient clinic of Hospital de San José de Bogotá, Colombia, between July 2015 and July 2016. Materials and methods: A descriptive cross-sectional study including 33 adult RTRs. Results: The mean age was 49.7 years (SD 11.6), 23 were females (69.7%), with a 4-year median time after transplant (IQR p:25:2 years - p:75:7 years). All patients were receiving maintenance immunosuppressive therapy. The prevalence of skin lesions was 81.8% (n = 27); the most prevalent were inflammatory and other type disorders (51.5%), followed by infections (33.3%). Three suspicious malignancy lesions were identified (9.0%). Biopsies demonstrated two basal-cell carcinomas (n = 2) and one infiltrating squamous cell carcinoma (n = 1). Conclusion: The frequency of cutaneous lesions is high in RTRs. This study design does not allowestablishing a cause-effect relationship between the type of immunosuppressive regimen received and the appearance of skin lesions. The importance of periodic dermatologic examinations of RTRs to detect skin andmucosal membrane disorders affecting the quality of life is emphasized.

Cancer mortality in the Mexican Social Security Institute, 1989-2013.

UNLABELLED: Objetive: To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. MATERIALS AND METHODS: A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age- and sex-adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. RESULTS: The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. CONCLUSION: The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment.

Síndrome de hidrocefalia normotensa del adulto / Adult Normal-Pressure Hydrocephalus Syndrome

La hidrocefalia normotensa es un síndrome clínico, que se caracteriza por el desarrollo progresivo de anomalías de la marcha, deterioro intelectual e incontinencia urinaria, la misma se diagnostica sobre todo, en pacientes mayores de 60 años. En las imágenes cerebrales se ve dilatación ventricular sin una importante atrofia cerebral. Ocurre como complicación tardía de infección intracerebral, hemorragia subaracnoidea y trauma craneal. Se presenta una paciente femenina de 69 años de edad, de tez blanca, con historia de hipertensión arterial desde hace 6 años con trastornos del equilibrio que han resultado en caídas con fracturas de cadera, clavícula, húmero y contusiones faciales. En los últimos años el trastorno del equilibrio empeoró e imposibilitó las tareas de la vida diaria, con lentitud en la marcha, asociado a un trastorno del lenguaje que, en su evolución, dificultó la comunicación verbal y, posteriormente, presentó dificultad para recordar hechos recientes además de incontinencia urinaria de urgencia(AU)

Normotensive hydrocephalus is a clinical syndrome, characterized by the progressive development of walking abnormalities, intellectual deterioration and urinary incontinence. It is mostly diagnosed in patients over 60 years of age. Ventricular dilation with no major brain atrophy is seen in cerebral images. It occurs as a late complication of intra-cerebral infection, subarachnoid hemorrhage and cranial trauma. A 69-year-old white female patient with a history of arterial hypertension for the past 6 years presented balance disorders that have led to falls resulting in fractures of hip, clavicle, humerus and facial contusions. In last years the disorder of the balance worsened and made her impossible to perform the daily life tasks, her march got slow, associated to a disorder of speech, that made difficult the verbal communication at her examination, later, she presented difficulty to remember recent facts, as well as urge urinary incontinence(AU)