Calidad del proceso en la ejecución del programa de Hipertensión Arterial

Introducción: Existe calidad en la atención de salud cuando los resultados o efectos de este proceso satisfacen los requisitos de los clientes externos e internos y cumplen, además, las normas, procedimientos y reglamentos institucionales del sistema. Objetivo: Evaluar la calidad del proceso de ejecución del Programa de Hipertensión Arterial. Material y Método: Se realizó una investigación en sistemas y servicios de salud en el Policlínico Ramón López Peña de Santiago de Cuba, desde enero hasta agosto de 2021, donde se evaluó la competencia y desempeño profesional de 81 médicos de familia. Un Comité de Expertos preestableció criterios, indicadores y estándares de evaluación. Resultados: La estrategia de seguimiento (51,8 %), estratificación del Riesgo Cardiovascular (55,5 %), el tratamiento según Riesgo Cardiovascular, y la elección del tipo tratamiento; fueron los temas menos conocidos por los médicos de familia. Solo en 33,3 % de los Consultorios Médicos de la Familia (CMF) se constató actividades grupales con pacientes hipertensos. La mayoría de los criterios en relación a la calidad de las consultas en las Historias Clínicas Individuales (HCI), fueron evaluados de inadecuados, siendo las más representativas, las interconsultas de especialidades afines y estratificación del riesgo cardiovascular (25,0 %). Conclusiones: Existen dificultades tanto en el desempeño como en la competencia profesional en la ejecución del programa de hipertensión arterial en el área de salud, lo cual afecta la calidad en su cumplimiento.

Introduction: There is quality in health care when the results or effects of this process meet the requirements of external and internal clients and also comply with norms, procedures, and institutional rules of the system. Objective: To evaluate the quality of process in the implementation of the arterial hypertension program. Material and Methods: Research was carried out on health systems and services at Ramón López Peña Policlinic in Santiago de Cuba from January to August 2021, wherein the competence and professional performance of 81 family physicians were evaluated. A committee of experts prearranged criteria, indicators, and evaluation standards. Results: Follow-up strategy (51.8%); Cardiac Risk Stratification (CRS), (55.5%); treatment according cardiovascular risk, and choice of treatment were the least known topics among family doctors. Group activities with hypertensive patients were confirmed in only 33% of Family Physician´ Offices (CMF). Most of the criteria in relation to the quality of consultations in Personal Clinical Histories proved inadequate, being interconsultations made to other related specialties and Cardiac Risk Stratification (CRS) the most representative. Conclusions: There are difficulties in both performance and professional competence in the implementation of the arterial hypertension program in the health area, affecting the quality of its compliance.

Adenosine A2A receptor activation stimulates collagen production in sclerodermic dermal fibroblasts either directly and through a cross-talk with the cannabinoid system.

Systemic sclerosis (SSc) is a connective tissue disease characterised by exaggerated collagen deposition in the skin and visceral organs. Adenosine A2A receptor stimulation (A2Ar) promotes dermal fibrosis, while the cannabinoid system modulates fibrogenesis in vitro and in animal models of SSc. Moreover, evidence in central nervous system suggests that A2A and cannabinoid (CB1) receptors may physically and functionally interact. On this basis, we investigated A2Ar expression and function in modulating collagen biosynthesis from SSc dermal fibroblasts and analysed the cross-talk with cannabinoid receptors. In sclerodermic cells, A2Ar expression (RT-PCR, Western blotting) was evaluated together with the effects of A2A agonists and/or antagonists on collagen biosynthesis (EIA, Western blotting). Putative physical and functional interactions between the A2A and cannabinoid receptors were respectively assessed by co-immuno-precipitation and co-incubating the cells with the unselective cannabinoid agonist WIN55,212-2, and the selective A2A antagonist ZM-241385. In SSc fibroblasts, (1) the A2Ar is overexpressed and its occupancy with the selective agonist CGS-21680 increases collagen production, myofibroblast trans-differentiation, and ERK-1/2 phosphorylation; (2) the A2Ar forms an heteromer with the cannabinoid CB1 receptor; and (3) unselective cannabinoid receptor stimulation with a per se ineffective dose of WIN55,212-2, results in a marked anti-fibrotic effect after A2Ar blockage. In conclusion, A2Ar stimulation induces a pro-fibrotic phenotype in SSc dermal fibroblasts, either directly, and indirectly, by activating the CB1 cannabinoid receptor. These findings increase our knowledge of the pathophysiology of sclerodermic fibrosis also further suggesting a new therapeutic approach to the disease.

Morbilidad oculta de cáncer de mama en el área de salud 28 de Septiembre / Hidden morbidity due to breast cancer at the health area 28 de Septiembre

Se efectuó un estudio descriptivo y transversal de 14 731 mujeres mayores de 30 años pertenecientes al área de salud del Policlínico 28 de Septiembre de Santiago de Cuba, desde febrero de 2008 hasta enero de 2009, para determinar la morbilidad oculta de cáncer de mama en estas pacientes. Se realizaron 9 diagnósticos de afecciones malignas, con supremacía de los grupos etarios de 50-59 y 70 y más años, así como del estadio 0-II b de la enfermedad. Hubo una asociación importante de algunos factores favorecedores del proceso morboso, tales como: menarquia precoz, antecedentes familiares de otros cánceres, dieta rica en grasas y hábito de fumar.

A descriptive and cross-sectional study was carried out in 14 731 women older than 30 years belonging to the health area of 28 de Septiembre Polyclinic in Santiago de Cuba, from February 2008 to January 2009, to determine hidden morbidity due to breast cancer in these patients. Nine diagnoses of malignant affections were made, with predominance of age groups 50-59 and 70 and over, as well as stage 0-II b of the disease. There was a significant association of some factors contributing to the disease process, such as early menarche, family history of other cancers, fat-rich diet and smoking habit.

Cannabinoids inhibit fibrogenesis in diffuse systemic sclerosis fibroblasts.

OBJECTIVE: It has been demonstrated that the endocannabinoid system is up-regulated in pathologic fibrosis and that modulation of the cannabinoid receptors might limit the progression of uncontrolled fibrogenesis. The aim of this study was to investigate whether the synthetic cannabinoid receptor agonist WIN55,212-2 could modulate fibrogenesis in an in vitro model of dcSSc. METHODS: The expression of cannabinoid receptors CB1 and CB2 was assessed in dcSSc fibroblasts and healthy control fibroblasts. To investigate the effect of WIN55,212-2 on dcSSc fibrogenesis, we studied type I collagen, profibrotic cytokines, fibroblast transdifferentiation into myofibroblasts, apoptotic processes and activation of the extracellular signal-related kinase 1/2 pathway prior to and after the treatment with the synthetic cannabinoid at increasing concentrations. RESULTS: Both CB1 and CB2 receptors were over-expressed in dcSSc fibroblasts compared with healthy controls. WIN55,212-2 caused a reduction in extracellular matrix deposition and counteracted several behavioural abnormalities of scleroderma fibroblasts including transdifferentiation into myofibroblasts and resistance to apoptosis. The anti-fibrogenic effect of WIN55,212-2 was not reverted by selective cannabinoid antagonists. CONCLUSIONS: Our preliminary findings suggest that cannabinoids are provided with an anti-fibrotic activity, thereby possibly representing a new class of agents targeting fibrosis diseases.