RESUMO
An expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populations.
Assuntos
Detecção Precoce de Câncer/métodos , Endoscopia Gastrointestinal , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Chile , Humanos , Fatores de Risco , Sociedades MédicasRESUMO
In response to the need to manage Antimicrobial Resistance (AMR), countries have produced National Action Plans (NAPs), which require detailed information of the AMR situation in all sectors. Considering the limited information that is publicly available for an analysis of the AMR situation in animal production, the FAO Regional Office for Latin America and the Caribbean (FAO RLC) developed the "FAO tool for a situation analysis of AMR risks in the food and agriculture sectors." The objective of this paper is to present the methodology developed for a qualitative evaluation of the risk factors of AMR toward animal and human health, based on terrestrial and aquatic production systems and their associated national public and private mitigation measures. The tool was developed reflecting the AMR epidemiological model and the guidelines to conduct a risk analysis of AMR from the Codex Alimentarius and WOAH. Applied in four stages of progressive development, the objective of the tool is to provide a qualitative and systematic assessment of the risks of AMR from animal production systems, to animal and human health, and to identify gaps in cross cutting factors in AMR management. The tool consists of three instruments: (i) a survey to collect data for a situation analysis of AMR risks; (ii) a methodological procedure for the analysis of the information obtained; (iii) instructions for the preparation of a national roadmap for the containment of AMR at a national level. Based on the results from the information analysis, a roadmap is prepared by guiding and prioritizing the needs and sectoral actions for the containment of AMR under an intersectoral, multidisciplinary and collaborative approach, and according to country priorities and resources. The tool helps to determine, visualize and prioritize the risk factors and challenges that contribute to AMR from the animal production sector and that need to be addressed to manage AMR.
RESUMO
La Asociación Chilena de Hepatología creó un registro de casos nuevos de hepatitis crónicas diagnosticadas con biopsia hepática entre los años 1994 y 1996. Se registran y clasifican de acuerdo a su etiología 106 pacientes altamente seleccionados con hepatitis crónica provenientes de la regiones metropolitana, quinta y segunda. De acuerdo a la etiología: 13 por ciento criptogénicas y 7 por ciento Virus B. La presencia de cirrosis al diagnóstico fue de 30 por ciento para las de origen viral C y 24 por ciento para las de origen autoinmune lo que podría afectar la respuesta a las alternativas terapéuticas. De acuerdo a estos resultados, deberíamos promover el diagnóstico más temprano en pacientes con alteraciones de laboratorio asintomáticas o notificando a los donantes de sangre en los que detecta alguna infección viral. En ausencia de otras instancias que realicen este tipo de evaluaciones, sugerimos repetir o mantener registros en lo posible de cobertura nacional, tanto para los pacientes con hepatitis crónica como para otras patologías hepáticas.