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ABSTRACT Objective. The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. Methods. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.
RESUMEN Objetivo. El uso racional de los medicamentos proporciona una estrategia de ahorro de costos para maximizar los resultados terapéuticos tanto en los países en desarrollo como en los países desarrollados. El objetivo de este estudio fue evaluar el uso racional de medicamentos para algunas enfermedades no transmisibles (ENT) seleccionadas en tres farmacias de hospitales públicos de Jamaica, usando los indicadores de prescripción de la Organización Mundial de la Salud (OMS). Métodos. En este estudio transversal retrospectivo se examinaron las prescripciones realizadas a pacientes ambulatorios adultos que incluían al menos un medicamento para enfermedades cardiovasculares, diabetes, cáncer, enfermedad pulmonar obstructiva crónica o asma, dispensadas entre enero y julio del 2019, utilizando los indicadores de prescripción para el uso racional de medicamentos de la OMS. Los datos se analizaron y expresaron mediante estadística descriptiva e inferencial. Para todos los análisis realizados se estableció un nivel de significación de p <0,05. Resultados. Se examinó un total de 1 500 prescripciones que incluían 5 979 medicamentos; la mayor parte de ellas correspondían a pacientes de sexo femenino de 42 a 60 años. Se observó que había polimedicación en el 35,6% (534) de las prescripciones, con un promedio de 4 y un máximo de 17 medicamentos por receta. En todos los centros se dispensó la mayor parte de los medicamentos prescritos, y el motivo principal para no hacerlo fue la falta de existencias del medicamento en cuestión. La prescripción de genéricos fue elevada en todos los centros y supuso más del 95% (5 722) de los medicamentos prescritos. En dos centros la prescripción se realizó en su totalidad de acuerdo con la Lista Modelo de Medicamentos Esenciales de la OMS, pero en el centro 1 no se alcanzó el objetivo por un 1,4%. Conclusiones. Se siguieron las directrices de la OMS para el uso racional de medicamentos en cuanto a la proporción de medicamentos prescritos de la Lista Modelo de la OMS y la proporción de antibióticos prescritos. El número de medicamentos por receta y la proporción de medicamentos prescritos mediante su nombre genérico no cumplieron con los criterios de la OMS. Sin embargo, las prescripciones estaban en consonancia con las directrices de tratamiento de las enfermedades no transmisibles seleccionadas.
RESUMO Objetivo. O uso racional de medicamentos é uma estratégia de contenção de custos para maximizar os resultados terapêuticos em países desenvolvidos e em desenvolvimento. O objetivo deste estudo foi avaliar o uso racional de medicamentos para algumas doenças não transmissíveis selecionadas em três farmácias de hospitais públicos na Jamaica a partir dos indicadores de prescrição preconizados pela Organização Mundial da Saúde (OMS). Métodos. Estudo transversal retrospectivo que avaliou receitas médicas de pacientes ambulatoriais adultos contendo pelo menos um medicamento prescrito para doença cardiovascular, diabetes, câncer, doença pulmonar obstrutiva crônica ou asma e dispensadas entre janeiro e julho de 2019. A avaliação foi realizada a partir dos indicadores de prescrição preconizados pela OMS para o uso racional de medicamentos. Os dados obtidos foram analisados por meio de estatísticas descritivas e inferenciais. O nível de significância de p <0,05 foi adotado em todas as análises. Resultados. Ao todo, foram analisadas 1 500 receitas médicas compreendendo 5 979 medicamentos. Em sua maioria, as receitas foram prescritas para pacientes do sexo feminino com idades entre 42 e 60 anos. A polifarmácia foi observada em 35,6% (534) das receitas; em média, foram prescritos 4 medicamentos, até um máximo de 17. As farmácias estudadas dispensaram a maior parte dos medicamentos receitados. O principal motivo para não fornecer algum medicamento foi o desabastecimento. O percentual de medicamentos genéricos foi alto em todos os locais, representando mais de 95% (5 722) do volume receitado. Houve plena observância da Lista Modelo de Medicamentos Essenciais da OMS nas receitas analisadas em dois dos locais estudos, e observância quase completa (diferença de 1,4%) no local 1. Conclusões. As diretrizes da OMS de uso racional de medicamentos foram cumpridas no que se refere ao percentual de medicamentos receitados de acordo com a Lista Modelo da OMS e o percentual de antibióticos receitados. Os critérios da OMS não foram cumpridos quanto ao número de medicamentos por receita e ao percentual receitado usando o nome genérico. Porém, os medicamentos foram receitados de acordo com as diretrizes terapêuticas para as doenças não transmissíveis selecionadas.
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Introducción: la traqueostomía es la abertura y el abocamiento de la tráquea al exterior realizada para lograr una vía aérea controlable y permeable. El abordaje puede ser percutáneo y abierto, bajo anestesia general o local, de forma urgente o programada. Objetivo: describir la técnica quirúrgica realizada habitualmente en el sistema de salud de Malvinas Argentinas y evaluar indicaciones y complicaciones. Materiales y métodos: estudio descriptivo retrospectivo que incluyó pacientes con traqueostomía, mayores de 18 años, sin distinción de sexo, realizada entre enero de 2015 y junio de 2018 en Malvinas Argentinas. Resultados: se operaron 72 pacientes, 11 anestesia local y 61 anestesia general; 15 urgencias y 57 programados. La edad promedio fue 34,7. La técnica utilizada fue abierta con incisión horizontal. Las principales indicaciones: intubación orotraqueal prolongada en 34 pacientes, síndrome obstructivo laríngeo agudo (SOLA) en 25 y destete dificultoso en 6. Las complicaciones más frecuentes: lesiones laringotraqueales en 9 pacientes, infección de herida quirúrgica en 5 y enfisema subcutáneo en 3. Discusión: la técnica abierta no es la única existente en la bibliografía, pero buenos resultados en nuestro servicio afirman su seguridad por mejor reconocimiento de estructuras anatómicas y abocamiento de la tráquea. No es posible concluir cuál técnica es superior con respecto a morbimortalidad. Existen diferencias en el lugar donde se realiza, y puede hacerse en quirófano o junto a la cama del paciente con adecuada asepsia. Conclusión: en la actualidad sigue siendo la técnica de elección para la realización de este procedimiento en nuestro servicio.
Introduction: Tracheostomy is the opening and entrance of the trachea to the outside carried out to achieve a controllable and patent airway. The approach can be percuta-neous and open, under general or local anesthesia, urgently or scheduled. Objective:Describe the surgical technique usually performed in Malvinas Argentinas Health System and evaluate indications and complications. Materials and methods: Retros-pective descriptive study, including of patients with tracheostomy, over 18 years of age, without distinction of sex, carried out between January 2015 and June 2018, in Malvinas Argentinas. Results: 72 patients underwent surgery, 11 local anesthesia, 61 general; 15 emergency, and 57 scheduled. Average age 34.7. The technique used was open with a horizontal incision. The main indications were prolonged orotra-cheal intubation in 34 patients, acute laryngeal obstructive syndrome (AOLS) in 25, and difficult weaning in 6. The most frequent complications were laryngotracheal injuries in 9 patients, surgical wound infection in 5, and subcutaneous emphysema in 3. Discussion: Open technique is not the only one existing in the literature, but the good results in our service confirm its safety due to better recognition of anatomical structures and opening of the trachea. It is not possible to conclude which technique is superior, with respect to morbidity and mortality. There are differences in the place where it is performed, and it can be done in the operating room or next to the patient's bed with adequate asepsis. Conclusion: Currently, it continues to be the technique of choice for performing this procedure in our service.
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Humans , Male , FemaleРеферат
É comum o armazenamento de medicamentos pelas famílias brasileiras, seja por uso contínuo, por sobras de um tratamento, pelo abandono ou para a automedicação. Dessa maneira o presente estudo objetiva analisar o estoque domiciliar de medicamentos da população adstrita na Estratégia Saúde da Família (ESF) de Rondonópolis-MT de fevereiro a junho de 2022, visando analisar as condições de armazenamento, realizar o levantamento de todos os fármacos dos domicílios em suas diferentes formas farmacêuticas e identificar o perfil de uso dos medicamentos conforme suas indicações terapêuticas. Trata-se de um estudo transversal, de caráter exploratório, e de base descritiva. Foi aplicado um questionário por domicílio durante visita domiciliar. Sobre a amostra estudada, 83,9% (n=281) dos entrevistados era do sexo feminino, faixa etária com predomínio de pessoas acima de 40 anos, com um nível de escolaridade baixo e renda familiar mais baixa. Dos participantes da pesquisa, 97,6% possuíam farmácia caseira. Esses medicamentos eram armazenados principalmente na cozinha, no quarto e na sala. As classes terapêuticas mais numerosas foram: analgésicos (14,2%), AINEs (8,9%) e anti-hipertensivos (7,7%). A quantidade de medicamentos armazenados foi significativamente maior entre praticantes de automedicação e participantes sem conhecimento adequado sobre o uso dos medicamentos, revelando a necessidade do farmacêutico como promotor de ações de educação em saúde sobre uso racional de medicamentos.
It is common for Brazilian families to store medications, whether for continuous use, leftover from treatment, due to abandonment, or for self-medication. Thus, this study aimed to analyze the home drug storage of the population attached to the Family Health Strategy (FHS) in Rondonópolis-MT from February to June 2022, to assess storage conditions, conduct a survey of all pharmaceuticals in the households in their different pharmaceutical forms, and identify the medication use profile according to their therapeutic indications. This was a cross-sectional, exploratory, descriptive-based study. A questionnaire was administered to each household during home visits. Regarding the study sample, 83.9% (n=281) of the respondents were female, predominantly over 40 years old, with a low level of education and lower family income. Of the participants, 97.6% had home pharmacies. These medications were primarily stored in kitchens, bedrooms, and living rooms. The most numerous therapeutic classes were analgesics (14.2%), NSAIDs (8.9%), and antihypertensive drugs (7.7%). The quantity of stored medications was significantly higher among those practicing self-medication and participants with inadequate knowledge about medication use, revealing the need for pharmacists as promoters of health education actions on rational drug use.
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Introduction: The flaps, whose function is to reduce or redirect tension during a closure, are classified based on their primary movement: transposition, advancement, and rotation, each with its characteristics, indications, and peculiarities. Combining the qualities of the transposition flaps with those of rotation, which make up the S-Apple flap, makes it more versatile and with better aesthetic results than the bilobed flap, which denotes the archetype for the appearance of the S-Apple. Method: Having the rotation and transposition flaps as an archetype, four flaps are made in the S-Apple flap, which are rotated and transposed to close the defect. This is excised in a circular format for the oncological safety of margins. The "S" of the flap is traced at a 30º angle in relation to the defect. The arm dimension must be the same diameter as the defect, with the flaps transposed as in a z-plasty, and the flap rotated to cover the defect, resulting from the exeresis of the lesion. Results: No necrosis, infection, dehiscence, recurrences, trapdoor scars, or rotation point elevation were observed. The scars were classified as satisfactory and extremely satisfactory. Conclusion: The S-Apple flap proved versatile and easy to mark with excellent aesthetic and functional results.
Introdução: Os retalhos, com função de reduzir ou redirecionar a tensão durante um fechamento, são classificados com base em seu movimento primário: transposição, avanço e rotação, cada um com suas características, indicações e peculiaridades. O arregimentar das qualidades dos retalhos de transposição com os de rotação, que compõem o retalho S-Apple, tornam-no mais versátil e com melhores resultados estéticos em relação ao retalho bilobado, que denota o arquétipo para o surgimento do S-Apple. Método: Tendo como arquétipo os retalhos de rotação e transposição, no retalho S-Apple são confeccionados quatro retalhos, que são rotacionados e transpostos para fechamento do defeito. Este é excisado em formato circular para segurança oncológica de margens. O "S" do retalho é traçado em um ângulo de 30º em relação ao defeito. A dimensão do braço deve ser do mesmo diâmetro do defeito, sendo os retalhos transpostos como em uma zetaplastia e o retalho rotacionado para cobrir o defeito, resultante da exérese da lesão. Resultados: Não foram observadas necroses, infecção, deiscências, recidivas, cicatrizes em alçapão e elevação em ponto de rotação. As cicatrizes foram classificadas como satisfatórias e extremamente satisfatórias. Conclusão: O retalho S-Apple se mostrou um retalho versátil de fácil marcação com excelentes resultados estéticos e funcionais.
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Objective:To evaluate the efficacy and safety of eltrombopag standard therapy in the treatment of patients with connective tissue disease (CTD) associated with thrombocytopenia who were non-responder to recombinant human thrombopoietin (rhTPO) or relapsed after discontinuation of rhTPO.Methods:Retrospectively analysis of clinical data of 4 cases presented with CTD associated with thrombocytopenia who were non-responder to rhTPO or relapsed after discontinuation of rhTPO, and then treated with eltrombopag from November 2017 to June 2022. The literature were reviewed on eltrombopag in the treatment of CTD associated with thrombocytopenia.Results:The platelet count of 4 patients increased to more than 30×10 9/L after 2 weeks administration of eltrombopag. The median time was 32 (14, 41) days for platelet counts returning to normal level. The dosage of eltrombopag was gradually reduced to maintain normal platelet count, which was helpful for tapering of glucocorticoid and other immunosuppressant. No adverse event was observed during the treatment. Conclusion:Eltrombopag is safe and effective for CTD associated with thrombocytopenia, for patients who are non-responders to rhTPO or relapsed after discontinuation of rhTPO treatment in particular.
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Glucagon-like peptide-2 (GLP-2) is a specific growth factor with intestinal protective effect. It plays a role in the regeneration and repair of intestinal injury through a variety of downstream signal pathways, which is mainly reflected in ensuring the integrity of intestinal structure, enhancing the function of intestinal barrier, increasing the blood supply of intestinal tract, and promoting the absorption of nutrients. Therefore, it is more and more popular in the clinical application of intestinal injury. This paper will summarize the latest research progress in the characteristics of GLP-2, its relationship with intestinal injury, mechanism of action and clinical application.
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Hallux valgus is one of the common diseases in foot and ankle surgery, mainly manifested as hallux toe valgus, first metatarsal adduction and first metatarsophalangeal joint dislocation or subluxation, resulting in a series of pathological changes. There are more than 200 surgical methods, and osteotomy can only be performed empirically, which is a great challenge for most doctors. The physical model generated by 3D printing technology can intuitively see the specific shape of the patient′s heel toes, and can make better preoperative planning through the model, which provides a better choice and method for the surgical method of hallux valgus and the design of intraoperative guide plate. With the rapid development of minimally invasive technology, the treatment of hallux valgus has also been greatly improved. This article mainly reviews the diagnosis and treatment of hallux valgus and the application progress of 3D printing.
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Multidisciplinary comprehensive treatment is the best medical model for liver cancer at present, and combined local and systemic treatment can prolong the survival period and improve the quality of life of patients. Local thermal ablation therapy represented by radiofrequency ablation has the advantages of precision and minimally invasive, easy operation, and precise efficacy, and has been increasingly widely used in the clinical application of hepatocellular carcinoma treatment. Radiofrequency ablation, as a precise and minimally invasive local thermal ablation therapy, can increase the efficacy, reduce the occurrence of complications of patients by combining with systemic therapies, such as surgery, interventional therapy, chemotherapy and targeted therapy. In this paper, the clinical application progress of radiofrequency ablation in hepatocellular carcinoma treatment is reviewed, and the combined therapeutic program of radiofrequency ablation in hepatocellular carcinoma in the era of multidisciplinary comprehensive treatment is discussed. For patients with advanced hepatocellular carcinoma, radiofrequency ablation combined with chemotherapy, targeted therapy and immunotherapy has shown good effects in the treatment, which is expected to bring more benefits to patients with advanced hepatocellular carcinoma in the future.
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As the elderly population continues to rise, the issue of disease diagnosis and treatment in the elderly population is becoming a hot topic of concern. Differentiated thyroid cancer is the most common endocrine malignancy in the world, and patients with differentiated thyroid cancer in the elderly have a worse clinical prognosis and higher risk of recurrence and metastasis. Moreover, due to the special characteristics and complexity of the elderly population, patients with differentiated thyroid cancer in the advanced age group have special features in terms of morbidity, preoperative diagnosis, treatment options, and postoperative management compared with other populations. This article reviews the current status of diagnosis and treatment of differentiated thyroid cancer in the elderly, taking into account the findings and opinions of domestic and international studies.
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The treatment concept and standardization of primary surgery for patients with differentiated thyroid cancer vary among different regions and different treatment centers in the same region, resulting in different reoperation rates for patients. Intraoperative experience, preoperative evaluation, surgical approach, and procedure may all influence the success rate of reoperation. In order to reduce the risk of surgery and complications, reoperation should be treated standardized, while combining the current diagnosis and treatment techniques to provide individualized treatment options for reoperation patients, under the premise of ensuring efficacy, to broaden the indications of surgery, make large incisions into small incisions, and change traditional open surgery into minimally invasive surgery, improve the quality of life of patients and confidence in coping with social stress. This paper will summarize the main content of preoperative assessment at the time of reoperation in patients with differentiated thyroid cancer, analyze the notes and rationally developing a surgical plan for patients, in the hope of attracting the same emphasis and normalizing the reoperation treatment, so as to achieve reoperation of the tumor R0 resection.
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Venous thromboembolism (VTE) is a common perioperative complication in patients with malignant tumors. Factors such as colorectal cancer itself and surgical treatment can increase the risk of perioperative VTE. In recent years, with the development of the concept of enhanced recovery after surgery, the understanding of cancer-associated venous thrombosis has deepened, and significant progress has been made in the risk assessment, prevention and treatment strategies of cancer-associated VTE. This article will review the pathogenesis, risk factors, risk assessment, prevention and treatment strategies of colorectal cancer-associated VTE, in order to provide evidence-based medical basis and research ideas for the standardized management and future research of colorectal cancer-associated VTE.
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Objective:To discuss the clinical effect of endovascular treatment of 15 patients with spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods:The clinical data of 15 patients with SISMAD treated with endovascular stent in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to July 2022 were collected and analyzed. The white blood cell, neutrophil percentage (NEUT%) and D-Dimer at admission, day 1 and day 3 after operation were analyzed and compared retrospectively. The time of abdominal pain at admission, YOO classification, angle from superior mesenteric artery to abdominal aorta(ASA), conservative treatment time, operation time, type and length of stent, vascular remodeling rate and long-term patency rate of stent were analyzed. The measurement data conforming to normal distribution was expressed as mean ± standard deviation ( ± s), t-test was used for comparison between the two groups. Measurement data of skewed distribution were expressed as M ( Q1, Q3), and non-parametric test was used for comparison between groups. Count data were expressed as rate or component ratio(%). The same variable was compared at different time points by repeated measurement data analysis of variance. Results:There were significant differences in white blood cell, NEUT% and D-Dimer between admission and postoperative day 3 in 15 patients. The time to admission for abdominal pain was 24.0(15.0, 78.0) hours. IVS type accounted for 46.7% of YOO type, and the ASA beyond 60° accounted for 66.7%. The conservative treatment time was (34.0±8.6) hours, moreover, the operation time was(153.0±37.8) min. Besides, self-expanding bare stent accounted for 85% of the stent types, moreover, the length of the stents beyond 60 cm was 50%. All patients were followed up for more than 24 months, and the vascular remodeling rate was(89.7±9.7)%.Conclusion:Endovascular self-expanding thin-wall stent placement has better vascular remodeling rate and patency rate for patients with IVS type.
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At present, surgical treatment is the most effective method for the treatment of hepatobiliary malignant tumor. However, due to the complex anatomical structure of hepatobiliary region, accompanied by vascular variation, and with the continuous update of medical concepts, the requirements for surgery are more strict. Traditional imaging examination has reached a bottleneck in the support of surgical treatment, while 3D printing technology is compared with the former. It showed strong advantages in preoperative program planning and improving the effect of intraoperative precise resection. At the same time, it also shows great potential for medical assistance and disease treatment in the production of bioactive models, and 3D printing technology has obviously enhanced the understanding of surgery for young doctors, and medical staff can create a variety of highly practical 3D printing models under the existing conditions. In the future, it is expected to overcome the limitations of materials and technology and bring higher therapeutic benefits for the majority of patients.
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Liver cancer is the second largest cancer in China, with the majority being hepatocellular carcinoma(HCC), which has a significant adverse impact on the lives and health of the Chinese people. Liquid biopsy is a new type of examination method with peripheral blood as the main examination subject. Compared with conventional tumor tissue pathology, liquid biopsy has less trauma, and the detection items can more accurately represent a certain tumor tissue group, more directly reflect the biological behavior of tumor tissue in the patient′s body. It is widely used in tumor screening, staging and grading, tumor individualized treatment monitoring, and prognosis evaluation. The following is mainly about the diagnosis, therapeutic effect evaluation and prognosis prediction of liquid biopsy in HCC from three aspects: circulating tumor DNA (ctDNA), exosome and circulating tumor cells (CTC), and the challenges faced by liquid biopsy technology at present are briefly described and its future development is prospected.
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Polypoidal choroidal vasculopathy (PCV) occurs in the middle-aged and elderly population and is characterized by abnormal intrachoroidal vascular patterns such as branching choroidal vascular networks and polypoidal dilatation of vessel terminals, subretinal orange nodular lesions and hemorrhagic or plasma retinal pigment epithelial detachment (PED), which can cause retinal hemorrhage or vitreous hematopoiesis and is one of the major blinding fundus lesions.Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs is currently the main method of PCV treatment, and has certain advantages in eliminating abnormal vascular networks and removing polypoidal lesions, reducing vascular exudation and promoting exudate absorption, and improving visual prognosis.However, frequent intravitreal drug injections increase the risk of infection and the treatment burden for patients.In addition, the high recurrence rate after treatment poses a significant challenge to clinical practice, so the search for new therapeutic agents that are durable and less costly is a focus of clinical research in PCV.The literature from abroad suggests that brolucizumab is a novel small-molecule anti-VEGF humanized monoclonal antibody with the advantages of high tissue penetration, high local drug concentration and bioavailability, small injectable dose, long-lasting efficacy and long injection interval, which brings new hope for the clinical treatment of PCV and improving the prognosis of affected eyes.Although the efficacy and safety of brolucizumab in the treatment of PCV have been well documented, the literature is mainly from Japan, India and Korea, and clinical practice data from China are still lacking.With the approval of the drug in several countries, it is believed that more PCV patients could benefit from this treatment in the near future.Ophthalmologists and researchers in China should closely follow the progress of brolucizumab in the treatment of PCV.
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Objective:To investigate the application value of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pancreaticobiliary maljunction (PBM) in children.Methods:The clinical data of 77 PBM children who underwent ERCP in General Surgery Department of Children's Hospital affiliated to Nanjing Medical University between January 2018 and December 2021 were retrospectively evaluated. Clinical characteristics, classification and post-operative nursing interventions were summarized, and vital signs, changes of biochemical markers and the occurrence of postoperative complications were compared and recorded.Results:77 patients were classified according to Japanese Study Group on Pancreaticobiliary Maljunction (JSGPM), including 34 patients with type A, 18 patients with type B, 21 patients with type C, and 4 patients with type D. There were 68 patients with congenital bile duct dilation and 9 patients without congenital bile duct dialtion. 92 ERCP procedures were performed under general anesthesia, and 91 cases were successful with a success rate of 98.91%. Among these cases, including 7 cases of endoscopic sphincterotomy, 28 cases of endoscopic balloon dilation of the nipple, 22 cases of endoscopic probe dilation, 22 cases of endoscopic stone removal by balloon or basket, 35 cases of endoscopic retrograde biliary stent drainage, 4 cases of endoscopic pancreatic duct drainage, 18 cases of endoscopic nasobiliary drainage, 2 cases of endoscopic nasobiliary drainage, and 14 cases of biliary stent removal. In 77 children with PBM, body temperature, FLACC score, and laboratory-related biochemical indexes including direct bilirubin, serum amylase, ALT, AST and CGT decreased significantly after ERCP, and all the differences were statistically significant (all P value <0.001). The incidence of postoperative complications was 15.38%(14/91), including hyperamylasemia in 9 cases (9.89%) and abdominal pain in 5 cases (5.49%). Conclusions:ERCP is safe and effective in the treatment of abnormal confluence of pancreatic duct in children.
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ABSTRACT Objective: To analyze the direct costs of materials, medicines/solutions and healthcare professionals required to treat men with prostate cancer using High Intensity Focused Ultrasound. Method: Quantitative, exploratory-descriptive research, single case study type. Data were collected from electronic medical records/printed documentation from the Operating Room of a public teaching and research hospital. Health professionals estimated the respective time spent on activities in the following stages: "Before anesthetic induction", "Before performing thermal ablation", "During thermal ablation" and "After performing thermal ablation". Costs were calculated by multiplying the (estimated) time spent by the unit cost of direct labor, adding to the measured cost of materials, medicines/solutions. Results: The measured costs with materials corresponded to US$851.58 (SD = 2.17), with medicines/solutions to US$72.13 (SD = 25.84), and estimated personnel costs to US$196.03, totaling US$1119.74/procedure. Conclusion: The economic results obtained may support hospital managers in the decision-making process regarding the adoption of the High Intensity Focused Ultrasound for the treatment of prostate cancer.
RESUMEN Objetivo: Analizar los costos directos de materiales, medicamentos/soluciones y profesionales de la salud necesarios para tratar a hombres con cáncer de próstata a través de High Intensity Focused Ultrasound. Método: Investigación cuantitativa, exploratoria-descriptiva, tipo estudio de caso único. Los datos se obtuvieron de registros médicos electrónicos/documentación impresa del Centro Quirúrgico de un hospital público de enseñanza e investigación. Los profesionales de la salud estimaron el tiempo respectivo dedicado a las actividades en las siguientes etapas: "Antes de la inducción anestésica", "Antes de realizar la ablación térmica", "Durante la realización de la ablación térmica" y "Después de realizar la ablación térmica". Los costos se calcularon multiplicando el tiempo (estimado) invertido por el costo unitario de la mano de obra directa, sumándolo al costo medido de materiales, medicamentos/soluciones. Resultados: Los costos medidos con materiales correspondieron a US$851,58 (DE = 2,17), con medicamentos/soluciones a US$72,13 (DE = 25,84) y los costos de personal estimados a US$196,03, totalizando US$1119,74/procedimiento. Conclusión: Los resultados económicos obtenidos podrán apoyar a los gestores hospitalarios en el proceso de toma de decisiones respecto a la adopción del High Intensity Focused Ultrasound para el tratamiento del cáncer de próstata.
RESUMO Objetivo: Analisar os custos diretos com materiais, medicamentos/soluções e profissionais de saúde requeridos à realização do tratamento de homens com câncer de próstata via High Intensity Focused Ultrasound. Método: Pesquisa quantitativa, exploratória-descritiva, do tipo estudo de caso único. Coletaram-se os dados em prontuários eletrônicos/documentações impressas do Centro Cirúrgico de um hospital público de ensino e pesquisa. Profissionais de saúde estimaram os respectivos tempos despendidos em atividades constantes das etapas: "Antes da indução anestésica", "Antes da execução da termoablação", "Durante a execução da termoablação" e "Após a execução da termoablação". Calcularam-se os custos multiplicando-se o tempo (estimado) despendido pelo custo unitário da mão de obra direta, somando-se ao custo mensurado dos materiais, medicamentos/soluções. Resultados: Os custos mensurados com materiais corresponderam a US$851,58 (DP = 2,17), com medicamentos/soluções a US$72,13 (DP = 25,84) e os custos estimados com pessoal a US$196,03, totalizando US$1119,74/procedimento. Conclusão: Os resultados econômicos obtidos poderão subsidiar os gestores hospitalares no processo decisório quanto à adoção do High Intensity Focused Ultrasound para o tratamento do câncer de próstata.
Тема - темы
Humans , Male , Prostatic Neoplasms , Costs and Cost Analysis , Direct Service Costs , Ultrasound, High-Intensity Focused, Transrectal , Therapeutic Uses , Hospital CareРеферат
Ayurveda being the science of life, primarily focuses on enhancing health of healthy individuals and removal of disease causing entities in a diseased person. Swarna (gold) has substantial therapeutic value, which has been indicated in different classics of Ayurveda. Swarna (gold) is desired by every human for many centuries. The desire is not only for its ornamental or commercial value but also because of its great medicinal value by which it increases strength and immunity. Swarna is converted into suitable dosage forms like Parpati, Pottali, Vati etc. Swarna kalpas are the unique blend of herbomineral formulations where Gold is used as one of the main ingredient. Swarna kalpas are widely used as therapeutic as well as life saving agents (in some emergencies). These formulations are helpful in treating many chronic disease conditions but it also acts miraculous when used for Rasayana purpose. In this review most commonly used Swarna kalpas such as Yogendra ras, Rasraj Ras, Vasant Kusumakar ras, Swarna malini vasant are discussed on the basis of different therapeutic angles
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Diabetes mellitus is a metabolic disease characterized by hyperglycemia. It is found that the incidence and mortality of abdominal aortic aneurysm (AAA) in diabetes mellitus patients are lower than that in non-diabetes mellitus patients. This review will present the protective role of diabetes mellitus and its treatment on the aortic disease process, aiming to provide more support for the clinical treatment of AAA.
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Hip arthroplasty is a common surgical method with good clinical effect. However, there are many influencing factors, among which the position of prosthesis is the key factor determining the prognosis. At present, 3D printing technology is widely used in hip replacement, which has an important effect in improving the position of hip replacement prosthesis. This paper reviews the application of 3D printing guide plate in hip arthroplasty.