ABSTRACT
BACKGROUND: Epidemiological studies on multisystem atrophy (MSA) are scarce. Our aim has been to analyse 10-year incidence, point prevalence, survival, and the time to diagnosis of MSA in Navarre, a northern Spanish region. METHODS: This is a population-based observational retrospective study, from 2012 to 2021, which covered the population of Navarre (followed until 31 December 2021). Data from various sources of health information were reviewed in order to identify all potential diagnoses of MSA, that were validated from medical records. Patients were included if they fulfilled the new Movement Disorder Society criteria. RESULTS: We observed a crude average annual incidence rate (IR) of 0.49/100,000 person-years, with the highest occurring in the age group of 60-69 years. No significant IR differences by sex or subtype were observed. Point prevalence in December 2021 was 2.43/100,000 inhabitants. Joinpoint analysis for global incidence and prevalence experienced stable annual rates during the whole period, showing an upward trend for prevalence without a statistically significant slop. The median age at symptom onset was 65 years (range 47-76). The median time to diagnosis was 36 months, without statistically significant differences between sex, age at diagnosis or subtypes. Median time of survival from clinical onset was 7 years. Age of onset above 70 years and autonomic onset were associated with reduced survival. CONCLUSIONS: This is the first population-based epidemiological study on MSA in Spain. It provides detailed incidence and prevalence data for MSA that may be useful for appropriate management of health resources.
Subject(s)
Multiple System Atrophy , Humans , Spain/epidemiology , Middle Aged , Male , Female , Aged , Retrospective Studies , Multiple System Atrophy/epidemiology , Multiple System Atrophy/diagnosis , Incidence , Prevalence , Age of Onset , Aged, 80 and overABSTRACT
PURPOSE: In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups. METHODS: 148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL. RESULTS: QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3-12 points). CONCLUSIONS: Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.
Subject(s)
Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/drug therapy , Quality of Life , Tamoxifen/therapeutic use , Aged , Female , Follow-Up Studies , Humans , Prognosis , Prospective Studies , Surveys and QuestionnairesABSTRACT
El catéter de Swan-Ganz es un dispositivo ampliamente utilizado para la monitorización del paciente crítico, así como durante lasintervenciones de cirugía cardiovascular. Sin embargo, su implantación y uso no están exentos del desarrollo de complicaciones.Presentamos un caso de atrapamiento del catéter con la sutura de cierre de la atriotomía izquierda durante una intervención de sustitución valvular mitral. (AU)
The Swan-Ganz catheter is a widely used device for monitoring critical patients, as well as during cardiovascular surgery. However,its implantation and use are not exempt from the development of complications. We present a case of catheter entrapment with theclosing suture of the left atriotomy during a mitral valve replacement procedure. (AU)
Subject(s)
Humans , Middle Aged , Thoracic Surgery/instrumentation , Catheterization, Swan-Ganz/instrumentation , Mitral Valve/surgeryABSTRACT
El Protomedicato era el Tribunal, cuyos miembros estaban sancionados por el rey, que se encargaba de controlar la docencia y el ejercicio profesional médico. Este hecho cambió claramente en la Nueva España a partir del siglo XVIII. En España, a mediados del mismo siglo, la universidad perdió parte de su papel controlador cuando la Corona encargó la formación quirúrgica a una serie de cirujanos educados en Europa. Esto lo hizo a través de los Reales Colegios de Cirujanos de la Armada, siendo el primero de ellos elde Cádiz. Estos poseían su propio Protomedicato y seleccionaban a los candidatos a ser estudiantes de medicina. Incluso tuvieron su propio Bachiller en Artes, imprescindible para la carrera médica. Su esquema pasó a la Nueva España a finales de ese siglo. Por otra parte, a finales del siglo XVII se funda lo que sería el embrión de la primera Real Academia de Medicina y Cirugía en Sevilla, en controversia con la universidad, donde se discutía sobre el avance en el campo de la medicina y de la cirugía y se enseñaban los nuevos conceptos histológicos, químicos, botánicos y farmacológicos, y también los quirúrgicos. Todo ello dio un vuelco a la cirugía. (AU)
The Protomedicato was the Court, whose members were sanctioned by the king, who was in charge of controlling teaching and medical professional practice. This fact clearly changed in New Spain from the 18th century on. In Spain in the mid-18th century, the university lost part of its controlling role when the Crown commissioned surgical training from a number of European-educated surgeons. This was done through the Royal Colleges of Surgeons of the Navy, the first of them being that of Cádiz. They had their own Protomedicato and selected candidates to be medical students. They even had their own Bachelor of Arts, essential to be able to be a medical student. His scheme passed to New Spain at the end of that century. On the other hand, at the end of the 17th century, what would be the embryo of the first Royal Academy of Medicine and Surgery in Seville was founded, in controversy with the university, where the advancement in the field of medicine and new histological, chemical, botanical and pharmacological concepts were taught, as well as surgical ones. all this turned the surgery upside down. (AU)