RESUMEN
At the global level, there are many challenges and opportunities for pharmaceutical personnel (professionals, technologists and technicians), mainly for those working at the outpatient pharmacies (Pharmaceutical Retail Establishments, in the context of the Colombian health system). Overall, Colombian outpatient pharmacies have limited their activities to selling medicines, while the World Health Organization (WHO) and the International Pharmaceutical Federation (FIP) have promoted their evolution toward a more patient-oriented practice. This focusing ranges from the procurement and supplying of medicines to pharmaceutical care services, oriented to ensure the best treatment for patients. Therefore, outpatient pharmacies play an important role in the improvement of pharmacotherapy and patient outcomes, promoting rational use of medicines and reducing healthcare costs (1). This kind of results have been gradually demonstrated in other countries (2). In that way, in Colombia there is a considerable need to create outpatient pharmacies which allow us improve outcomes for patients care, increase access to healthcare system care (specially for vulnerable populations) and, to provide specific-medication tools for reach successful therapies. By including patient education, it is possible to ensure the best health outcomes, to improve patient satisfaction and to enhance costeffectiveness relationship.
Asunto(s)
Humanos , Farmacias , Atención Ambulatoria , Farmacéuticos , Servicios Farmacéuticos , ColombiaRESUMEN
BACKGROUND: Zenker's diverticulum is a protrusion of the pharyngeal mucosa through a weak area of the posterior wall. It is a rare disorder with an incidence in Mexico of ~0.04% of the population. Its pathophysiology is not yet completely understood. Treatment is surgical and is performed in case of complications. Clinic case: We present the case of a 67 year-old male patient without comorbidities. Symptoms appeared 15 months prior to admission with occasional dysphagia to solids and liquids, breathing difficulty at night, drooling, halitosis, 3 kg weight loss in 2 months, and adequate appetite. Diagnosis of Zenker's diverticulum was established by imaging method and endoscopy. A diverticulectomy with cricopharyngeal muscle myotomy was successfully performed. Liquid diet was started the third postoperative day and progressed without complications; the patient was discharged on the sixth postoperative day without complications. Follow-up at 1 year was successful without recurrence. CONCLUSION: Minimally invasive procedures are useful in patients with comorbidities and for the short anesthesia time and hospitalization. Referring to our field of work, the open treatment is best to relieve symptoms rather than endoscopic procedures because the training for advanced endoscopic procedures is a problem due to lack of infrastructure and specialized personnel.
Antecedentes: los divertículos de Zenker son protrusiones de la mucosa faríngea a través de una zona débil de su pared posterior. Es un padecimiento raro, con una incidencia en México de aproximadamente 0.04% de la población. El tratamiento indicado es quirúrgico. Caso clínico: paciente masculino de 67 años de edad, que 15 meses antes del diagnóstico experimentó síntomas de: disfagia a sólidos y ocasionalmente a líquidos, ahogo por las noches, sialorrea, halitosis, pérdida de 3 kg en dos meses y aumento del apetito. El diagnóstico se confirmó a través de métodos de imagen y endoscopia. Se realizó exitosamente una diverticulectomía con miotomía de músculo cricofaríngeo. Al tercer día de operado pudo ingerir líquidos sin complicaciones, y fue dado de alta al sexto día. Un año después no había mostrado recurrencias. Conclusión: los procedimientos de invasión mínima son útiles en pacientes con comorbilidades porque requieren corto tiempo de anestesia y de hospitalización. En este medio, el tratamiento abierto es la mejor técnica para su resolución, ya que la capacitación para efectuar procedimientos endoscópicos representa un problema por la falta de infraestructura y personal especializado.