ABSTRACT
Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...
Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...
Subject(s)
Humans , Male , Female , Multiple Sclerosis/drug therapy , Immunologic Factors/therapeutic use , National Health Programs , Public Sector , Chile , Insurance, Health , Interferon-beta/therapeutic use , Patient Selection , Pilot Projects , Peptides/therapeutic useSubject(s)
Adult , Female , Humans , Male , Middle Aged , Nerve Degeneration/etiology , Spinal Cord , Spinal Cord Diseases/etiology , /complications , Paresthesia/etiologyABSTRACT
Background: Subacute combined degeneration is a clinical manifestation of vitamin B12 deficiency, that we observe with unusual frequency. Aim: To report a series of eleven patients with subacute combined degeneration. Patients and methods: Retrospective analysis of 11 patients hospitalized in a public hospital in Santiago, between March 2001 and February 2003. All had a myelopathy of more than three weeks of evolution with serum vitamin B12 levels of less than 200 pg/ml. Results: A risk factor was identified in 10 cases and the most common was an age over 60 years old. The main presenting symptom was the presence of paresthesias. On admission, sphincter dysfunction, posterior column and pyramidal syndromes coexisted in nine patients. A level of sensitive deficit was detected in six. Ten patients had macrocytosis and eight were anemic. Serum vitamin B12 was measured in ten and in nine, it was below 200 pg/ml. The mean lapse between onset of symptoms and treatment was eight months. All received intramuscular vitamin B12 in doses on 1,000 to 10,000 IU/day. Sphincter dysfunction and propioception were the first symptoms to improve. Conclusions: Subacute combined degeneration must be suspected in patients older than 60 years with a subacute myelopathic syndrome and low serum vitamin B12 levels.
Subject(s)
Humans , Male , Female , Middle Aged , Nerve Degeneration/pathology , Spinal Cord Diseases/etiology , Spinal Cord/pathology , /complications , Acute Disease , Magnetic Resonance Spectroscopy , Paresthesia/etiology , Retrospective Studies , Spinal Cord Diseases/blood , Spinal Cord Diseases/pathology , /blood , /pathologyABSTRACT
Se presenta la experiencia en el diagnóstico y tratamiento de 4 casos de actinomicosis colorrectal (ACR) atendidos en un período de 9 años, excluídas las de origen apendicular. La forma clínica de presentación fue la masa tumoral estenosante de colon sigmoides en 3 casos y la estenosis rectal con trayecto fistuloso ciego en el restante. El diagnóstico se sospechó luego de repetidas biopsias negativas endoscópicas o quirúrgicas y en un caso se certificó por el hallazgo del Actimomices Israelli en un absceso tuboovárico que obligó a una resección de colon con coloetomía a lo Hartmann. La prueba terapéutica fue indicativa de esta infección crónica en el resto de los casos, lográndose la desaparición completa de la masa tumoral y de la estenosis respectivamente. Luego de un tratamiento antibiótico con penicilina sódica seguida de tetraciclina o amoxicilina que duró entre 6 y 12 meses, se logró reconstituir el tránsito intestinal en todos los casos