Global Assessment of Palliative Care Need: Serious Health-Related Suffering Measurement Methodology.

CONTEXT: Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration - SHS 1.0 - was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions. OBJECTIVES: In this paper, an updated methodology - SHS 2.0 - is presented building on the work of the Lancet Commission and detailing calculations, data requirements, limitations, and assumptions. METHODS AND RESULTS: The updates to the original methodology focus on measuring the number of people who die with (decedents) or live with (non-decedents) SHS in a given year to assess the number of people in need of palliative care across health conditions and populations. Detail on the methodology for measuring the number of days of SHS that was pioneered by the Lancet Commission, is also shared, as this second measure is essential for determining the health system responses that are necessary to address palliative care need and must be a priority for future methodological work on SHS. CONCLUSIONS: The methodology encompasses opportunities for applying SHS to future policy making assessment of future research priorities particularly in light of the dearth of data from low- and middle-income countries, and sharing of directions for future work to develop SHS 3.0.

Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries.

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.

Simultaneous Volumetric and Functional Assessment of the Right Ventricle in Hypoplastic Left Heart Syndrome After Fontan Palliation, Utilizing 3-Dimensional Speckle-Tracking Echocardiography.

BACKGROUND: Right ventricular (RV) volumetric and functional assessments are both crucial for the management of patients with hypoplastic left heart syndrome (HLHS). 3-dimensional echocardiography (3DE) for volume measurements and 2D speckle-tracking echocardiography (2D-STE) for strain analysis are performed separately. 3D-STE is capable of evaluating those parameters simultaneously and providing principal strain (PS), unifying the concepts of myofiber orientation and contraction into a single, maximal contractile direction. However, the application of 3D-STE to HLHS has not been studied and so became the aim of our study.Methods and Results:64 HLHS patients after Fontan palliation underwent 3D-STE analysis measuring RV end-diastolic volume index (EDVi), ejection fraction (EF), global PS (GPS), global circumferential strain (GCS), and global longitudinal strain (GLS). Volume measurements were compared between 3D-STE and 3DE, and strains were compared between 3D- and 2D-STE. EDVi and EF showed strong correlations between 3D-STE and 3DE (r=0.93 and 0.87, respectively). GCS and GLS showed moderate correlations between 3D- and 2D-STE (r=0.65 and 0.61, respectively). GPS showed highest magnitude and excellent correlation with EF (r=-0.95). CONCLUSIONS: Simultaneous volumetric and functional assessment by 3D-STE was a useful method in this HLHS cohort. PS is a promising parameter for evaluating the RV function of HLHS, which could be useful during longitudinal follow-up.

Tuberculosis de mama en el Hospital Carlos Alberto Seguín Escobedo, EsSalud Arequipa 2017 / Breast tuberculosis in the Carlos Alberto Seguín Escobedo Hospital, EsSalud Arequipa 2017

Objetivo: "Tuberculosis de Mama en el Hospital Carlos Alberto Seguin Escobedo, Essalud Arequipa 2017". Estudio transversal, Documentario, evaluando las características clínicas, sociodemográficas, histológicas. Resultados: Evidenciamos 70 pacientes con tuberculosis de mama, Edad promedio de 37 años. Compromiso glandular la mama izquierda es la más afectada en 47%, Un 56% no presento ningún tipo de secreción, El 100% de pacientes presentaban Bacilos-copia negativa. El estudio de Reacción en Cadena de la Polimerasa, encontramos dos casos positivos; El diagnostico histopatológico de Mastitis Crónica Granulomatosa está presente en un 86%, En la coloración Zielhn-Neelsen realizadas un 100% son Negativas, presencia Células de Langhans en 36% de las biopsias realizadas. Dos pacientes presentaron reacción dérmica en la mama afectada. En relación a la escala BIRADS para ecografía evidenciamos que un 56% de las pacientes presentaban estadiaje 2, probablemente a que la Sensibilidad y Especificidad es mayor para los casos de Cáncer de mama. Conclusión: El promedio de tiempo de enfermedad es de 4 meses, El tiempo de enfermedad desde 1 mes hasta 3 años. Predomina la afectación de la mama izquierda y en ella el cuadrante ínfero-externo. El dolor presente en casi todas las pacientes, más de la mitad de pacientes no presentaban secreción en la lesión mamaria, No tenía compromiso axilar. Reacción en Cadena de la Polimerasa (PCR) es altamente predictivo para TBC de mama, Más de la mitad presentaba un birads ecográfico 2 y casi la totalidad presentaba un episodio de stress emocional. Palabras Clave: Incidencia, Prevalencia, Características Clínicas, Tuberculosis, Mama.

Ileítis por citomegalovirus en paciente inmunocompetente / No disponible

El citomegalovirus (CMV) es un virus perteneciente a la familia de los Herperviridae. La infección puede causar una enfermedad grave en inmunodeprimidos, sin embargo también puede afectar a inmunocompetentes, y da lugar a cuadros clínicos generalmente autolimitados, aunque se han descrito casos graves que pueden llevar a la muerte. Presentamos un caso de ileítis por CMV con manifestaciones clínicas graves que motivaron intervención quirúrgica urgente en un paciente inmunocompetente(AU)

Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient(AU)

Calidad de sueño en pobladores de una comunidad andina a 3200 msnm en Perú: Ancash-Perú / Sleep quality of andean inhabitants at 3200 m. Ancash-Perú

Objetivo: Describir la calidad de sueño en los pobladores andinos de Huaripampa-Ancash (3 200 msnm). Material y métodos: Se utilizó el Índice de Calidad de Sueño de Pittsburgh (ICSP). Se calculó el tamaño de la muestra (n=92) mediante el método de proporciones, y se realizó una aleatorización sistemática de casas, encuestando a los pobladores presentes que cumplieron con los criterios de inclusión. Resultados: Se encuestaron a 83 pobladores, 46% fueron hombres, la edad media fue de 40,59 +/- 17,5 (18-65 años) y la mediana del puntaje del PSQI fue de 6 más menos 4,5 (RIC) [2-18]. Se encontró que 53 (63,8%) fueron malos durmientes. La alteración de sueño más frecuente fue el insomnio, presente en 47% de la población. Conclusiones: La alteración del sueño es un problema frecuente en esta población. Una herramienta como la del Índice de calidad de sueño de Pittsburgh, con algunas modificaciones, puede ser implementada en poblaciones rurales-andinas.

Objective: To describe the sleep quality in the inhabitants of Huaripampa-Ancash. Material and methods: We usedthe Pittsburgh Sleep Quality Index (PSQI). Using the method of proportions was calculated the sample size (n = 92), and there was a systematic randomization of houses, surveying the present inhabitants that meet the inclusion criteria. Results: There were surveying a total of 83 inhabitants, 38 (46%) were men, mean age was 40.59 +/- 17.5 (18-65 years old) and the average score of PSQI was 6 +/- 4.5 [2 -18], 53 (63.8%) of the population were poor sleepers. The most frequent disruption of sleep was insomnia, which was present in 39 (47%) inhabitants. Conclusions: Symptoms associated with various sleep disorders are common in rural Andean population. A tool such as the sleep quality index in Pittsburgh, with some modifications, can be implemented in rural Andean populations.