Tasa de afectación de los márgenes quirúrgicos tras la cirugía conservadora de mama y estimación de los costes directos / Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs

Objetivo: Valoración de la tasa de reintervención en pacientes con márgenes de resección positivos tras cirugía conservadora inicial por cáncer de mama y estimación del coste para el hospital. Métodos: Estudio observacional de la tasa de afectación de los márgenes quirúrgicos de la pieza de resección tras la cirugía conservadora inicial en mujeres con carcinoma de mama invasor durante los años 2018-2019 en el H. U. de Tarragona Joan XXIII (HUTJ23), estableciendo en qué casos fue precisa la realización de una segunda intervención sobre la mama. Se estiman los costes directos añadidos que supone el segundo procedimiento quirúrgico y se compara con el gasto según los pesos establecidos por el Servicio Catalán de Salud según el nivel del hospital y los Grupos Relacionados por el Diagnóstico (GRD) fijados por el Sistema Nacional de Salud.Resultados: Se incluyó a 146 pacientes con diagnóstico de cáncer de mama invasor. Encontramos márgenes positivos tras la cirugía conservadora inicial en el 20,55% de los casos. Se reintervino al 19,17% del total de pacientes, generando las reintervenciones un coste de 129.696,089€, siendo 82.654,34€ para cirugía conservadora (3.757,01€ de media por paciente) y de 47.042,55€ en las mastectomías (6.720,36€ de media por paciente). Conclusiones: La afectación de los márgenes tras cirugía conservadora de la mama es sinónimo de reintervención, lo que supone una serie de costes directos que dependen del tipo de cirurgia y el régimen escogido (ambulatoria u hospitalizada). Es recomendable controlar los factores que inciden en los márgenes afectos para minimizar su impacto. (AU)

Objective: Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. Method: 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. Results: The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient).Conclusions: Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact. (AU)

Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs.

OBJECTIVE: Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. METHOD: 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. RESULTS: The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129,696.89, € 82,654.34 in conservative surgeries (€ 3757.01 on average per patient) and € 47,042.55 in mastectomies (€ 6720.36 on average per patient). CONCLUSIONS: Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.

Evolution of Serum Acute-Phase Glycoproteins Assessed by 1H-NMR in HIV Elite Controllers.

Elite controllers (ECs) are an exceptional group of people living with HIV (PLWH) who maintain undetectable viral loads (VLs) despite not being on antiretroviral therapy (ART). However, this phenotype is heterogeneous, with some of these subjects losing virological control over time. In this longitudinal retrospective study, serum acute-phase glycoprotein profile assessed by proton nuclear magnetic resonance (1H-NMR) was determined in 11 transient controllers (TCs) who spontaneously lost virological control and 11 persistent controllers (PCs) who persistently maintained virological control over time. Both PCs and TCs showed similar acute-phase glycoprotein profiles, even when TCs lost the virological control (GlycB, p = 0.824 and GlycA, p = 0.710), and the serum acute-phase glycoprotein signature in PCs did not differ from that in HIV-negative subjects (GlycB, p = 0.151 and GlycA, p = 0.243). Differences in serum glycoproteins A and B were significant only in ECs compared to HIV-typical progressors (TPs) with < 100 CD4+ T-cells (p < 0.001). 1H-NMR acute-phase glycoprotein profile does not distinguish TCs form PCs before the loss of viral control. ECs maintain a low-grade inflammatory state compared to TPs. PCs revealed a closer serum signature to HIV-negative subjects, reaffirming this phenotype as a closer model of functional control of HIV.

Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs. / Tasa de afectación de los márgenes quirúrgicos tras la cirugía conservadora de mama y estimación de los costes directos.

OBJECTIVE: Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. METHOD: 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. RESULTS: The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient). CONCLUSIONS: Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.

Incidencia y letalidad del ictus isquémico en la población mayor de 60 años del área de Tarragona, España (2008-2011) / Incidence and lethality of ischaemic stroke among people 60 years or older in the region of Tarragona (Spain), 2008-2011

Introducción. La información existente sobre la epidemiología del ictus en nuestro país es limitada. Este estudio analizó la incidencia y mortalidad por ictus isquémico en la población general mayor de 60 años del área de Tarragona. Pacientes y métodos. Estudio de cohortes de base poblacional que incluyó a 27.204 personas de 60 o más años adscritas a nueve áreas básicas de salud en la comarca del Tarragonès. Se realizó un seguimiento prospectivo durante tres años, en los que se seleccionaron todos los episodios de ictus isquémicos ocurridos entre los miembros de la cohorte desde el 1 de diciembre de 2008 hasta el 30 de noviembre de 2011. Se incluyeron exclusivamente episodios con diagnóstico validado tras la revisión de la historia clínica y se excluyeron aquellos casos sin confirmación diagnóstica por neuroimagen. Resultados. Se observó un total de 343 casos confirmados de ictus isquémico, lo cual supuso una incidencia de 453 episodios por 100.000 personas/año (intervalo de confianza del 95% = 408-504). La incidencia fue mayor en hombres que en mujeres (531 frente a 392 por 100.000 personas/año; p < 0,001) y aumentó sustancialmente con la edad (195 frente a 517 y frente a 1.006 por 100.000 personas/año en 60-69, 70-79 y ≥ 80 años, respectivamente; p < 0,001). La incidencia fue más de ocho veces superior entre las personas con antecedentes de ictus previo en comparación con aquellas sin historia de ictus previo (2.962 frente a 340 por 100.000 personas/año; p < 0,001). El índice de letalidad global fue del 13%, y alcanzó el 21% entre las personas de 80 o más años. Conclusiones. La morbimortalidad por ictus es considerable en nuestra población. Medidas preventivas y tratamientos más eficaces son imperativos (AU)

Introduction. Data available about the epidemiology of stroke is limited. This study investigated incidence and lethality of ischaemic stroke among the general population over 60 years in the region of Tarragona. Patients and methods. Population-based cohort study that included 27,204 individuals ≥ 60 years assigned to nine Primary Care Centers in the Tarragonès county (Catalonia, Spain), who were prospectively followed between December 1st, 2008 and November 30th, 2011. During follow-up, all episodes of ischaemic stroke were recruited among cohort members. Only confirmed ischaemic cases (confirmed by neuroimaging and validated alter checking hospital medical records) were included. Results. An amount of 343 confirmed cases of ischaemic stroke were observed, which means a global incidence rate of 453 episodes per 100,000 persons/year (95% confidence interval = 408-504). Incidence was higher among men than in women (531 vs 392 per 100,000; p < 0.001) and increases substantially with increasing age (195 vs 517 vs 1,006 per 100,000 in 60-69 years, 70-79 years and ≥ 80 years, respectively; p < 0.001). Incidence was eight times greater among persons with history of prior ictus as compared with those without history of ictus (2,962 vs 340 per 100,000; p < 0.001). Overall lethality rate was 13%, reaching 21% among patients ≥ 80 years. Conclusion. Morbid-mortality by ischaemic ictus remains considerable among our population. Preventive measures and more efficacious therapies are imperative (AU)

[Incidence and lethality of ischaemic stroke among people 60 years or older in the region of Tarragona (Spain), 2008-2011]. / Incidencia y letalidad del ictus isquemico en la poblacion mayor de 60 años del area de Tarragona, España (2008-2011).

INTRODUCTION: Data available about the epidemiology of stroke is limited. This study investigated incidence and lethality of ischaemic stroke among the general population over 60 years in the region of Tarragona. PATIENTS AND METHODS: Population-based cohort study that included 27,204 individuals >= 60 years assigned to nine Primary Care Centers in the Tarragones county (Catalonia, Spain), who were prospectively followed between December 1st, 2008 and November 30th, 2011. During follow-up, all episodes of ischaemic stroke were recruited among cohort members. Only confirmed ischaemic cases (confirmed by neuroimaging and validated alter checking hospital medical records) were included. RESULTS: An amount of 343 confirmed cases of ischaemic stroke were observed, which means a global incidence rate of 453 episodes per 100,000 persons/year (95% confidence interval = 408-504). Incidence was higher among men than in women (531 vs 392 per 100,000; p < 0.001) and increases substantially with increasing age (195 vs 517 vs 1,006 per 100,000 in 60-69 years, 70-79 years and >= 80 years, respectively; p < 0.001). Incidence was eight times greater among persons with history of prior ictus as compared with those without history of ictus (2,962 vs 340 per 100,000; p < 0.001). Overall lethality rate was 13%, reaching 21% among patients >= 80 years. CONCLUSION: Morbid-mortality by ischaemic ictus remains considerable among our population. Preventive measures and more efficacious therapies are imperative.

TITLE: Incidencia y letalidad del ictus isquemico en la poblacion mayor de 60 años del area de Tarragona, España (2008-2011).Introduccion. La informacion existente sobre la epidemiologia del ictus en nuestro pais es limitada. Este estudio analizo la incidencia y mortalidad por ictus isquemico en la poblacion general mayor de 60 años del area de Tarragona. Pacientes y metodos. Estudio de cohortes de base poblacional que incluyo a 27.204 personas de 60 o mas años adscritas a nueve areas basicas de salud en la comarca del Tarragones. Se realizo un seguimiento prospectivo durante tres años, en los que se seleccionaron todos los episodios de ictus isquemicos ocurridos entre los miembros de la cohorte desde el 1 de diciembre de 2008 hasta el 30 de noviembre de 2011. Se incluyeron exclusivamente episodios con diagnostico validado tras la revision de la historia clinica y se excluyeron aquellos casos sin confirmacion diagnostica por neuroimagen. Resultados. Se observo un total de 343 casos confirmados de ictus isquemico, lo cual supuso una incidencia de 453 episodios por 100.000 personas/año (intervalo de confianza del 95% = 408-504). La incidencia fue mayor en hombres que en mujeres (531 frente a 392 por 100.000 personas/año; p < 0,001) y aumento sustancialmente con la edad (195 frente a 517 y frente a 1.006 por 100.000 personas/año en 60-69, 70-79 y >= 80 años, respectivamente; p < 0,001). La incidencia fue mas de ocho veces superior entre las personas con antecedentes de ictus previo en comparacion con aquellas sin historia de ictus previo (2.962 frente a 340 por 100.000 personas/año; p < 0,001). El indice de letalidad global fue del 13%, y alcanzo el 21% entre las personas de 80 o mas años. Conclusiones. La morbimortalidad por ictus es considerable en nuestra poblacion. Medidas preventivas y tratamientos mas eficaces son imperativos.

Papel del factor demanda en la prescripción de antibióticos / Role of demand in the prescription of antibiotics

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