The Role of Perceived Utility of Full Health in Age Weighting.

OBJECTIVES: People often give different weights to quality-adjusted life-years (QALYs) gained by different socioeconomic groups. It is well known that QALY gains of younger patients generally get more weight than the same QALY gains accruing to older patients. This study aims to separate these age-related preferences into "pure age weighting" and age weighting caused by full health not perceived as being the same for the old as for the young. METHODS: We apply a person trade-off method in a large sample representative (N = 500) of the Dutch general adult population to estimate age weighting factors. We describe health as a percentage of what is considered full health for a given age, for which we obtain a proxy in a separate task. RESULTS: A high amount of age weighting is observed, with QALYs to 20-year-old patients receiving approximately 1.5 times as much weight as QALYs to 80-year-old patients. At the same time, we see that individuals do not perceive full health to be the same for young and older people. In fact, the age weighting disappears once we control for these differences in full health perceptions. CONCLUSIONS: Respondents had strong preferences for the young relative to the old, but these preferences were related to full health perceptions, that is, more weight being assigned to younger because full health is at a higher absolute level for them than for the old.

Esófago negro como causa de hemorragia digestiva alta: reporte de un caso / Black esophagus as a cause of upper gastrointestinal bleeding: a case report

Resumen La esofagitis necrotizante aguda es una entidad poco común que afecta sobre todo a ancianos. La presentación clínica más común es hemorragia digestiva alta. El pronóstico depende de las enfermedades de base con una mortalidad de hasta el 50 %. Se presenta el caso de un varón de 77 años con historia de una semana de melena, 3 episodios de hematemesis y epigastralgia. La endoscopia digestiva alta reveló una mucosa con necrosis en parches y fibrina en el esófago medio y distal. La biopsia de esófago fue compatible con necrosis de mucosa.

Abstract Acute necrotizing esophagitis is a rare entity that affects mainly elderly patients. The most common clinical presentation is upper gastrointestinal bleeding. The prognosis depends on the underlying diseases, with a mortality of up to 50%. This is the case of a 77-year-old male patient who presented with melena, three episodes of hematemesis, and epigastric pain for a week. Upper endoscopy revealed mucosa with spotty necrosis and fibrin in the middle and distal esophagus. Esophageal biopsy was compatible with mucosal necrosis.

[Autoimmune pancreatitis type 1: a case report]. / Pancreatitis autoinmune tipo 1: reporte de caso.

Autoimmune pancreatitis type 1 (AIP) is the pancreatic manifestation of IgG4-related disease. The most frequent presentation of AIP is with obstructive jaundice. For definite diagnosis of type 1 Autoimmune pancreatitis international consensus diagnosis criteria (ICDC) for AIP are used. ICDC criteria include pancreatic parenchymal imaging, ductal imaging, serology, other organ involvement, histology, and response to steroid. We report a 52-years-old woman with rheumatoid arthritis without treatment presented with two months of abdominal pain in up-right quadrant with moderate intensity. She also presented jaundice, acholia, xerophtalmia, xerostomia, and a weight loss of 5 pounds. On examination jaundice, symmetrically enlarged submandibular glands, and epigastric pain was observed. On laboratory, a cholestasis pattern and conjugated bilirubin predominance was found. CT Abdominal, CMR revealed a dilated common bile duct with a diffuse pancreatic enlargement with delayed enhancement. Immunological studies show a IgG4 610 u/l and ANA 1/640. The patient responds to steroid clinically and in the laboratorial values. In conclusion, autoimmune pancreatitis type 1 should be suspected in case of an obstructive jaundice with a pancreatic inflammatory image, and complete ICDC criteria for a definite diagnosis.

Clinical Pharmacology and the Risks of Polypharmacy in the Geriatric Patient.

Elderly people have several characteristics that make them unique. They have several factors such as environmental factors and demographic factors such as age, sex, socioeconomic level, and schooling, which contribute to these differences being accentuated. As one ages, these various organic and systemic features are accentuated. The pace varies between people, and organs and systems suffer from several normal and adverse changes that make them more or less susceptible to diseases and injuries, and the medications are responsible for many of these threats. This article raises awareness about these changes.

Pancreatitis autoinmune tipo 1: reporte de caso / Autoimmune pancreatitis type 1: a case report

La pancreatitis autoinmune tipo 1 es una enfermedad de baja prevalencia siendo más frecuente en varones, se encuentra incluida dentro de las enfermedades relacionadas a IgG4. Esta patología puede debutar como un síndrome colestásico y el diagnóstico se realiza según los criterios del consenso internacional para pancreatitis autoinmune (ICDC) que incluye una imagen típica, serología, compromiso de otros órganos, histología y respuesta al tratamiento con corticoides. Presentamos el caso de una mujer de 52 años con antecedente de artritis reumatoide sin tratamiento que acude con tiempo de enfermedad de 2 meses caracterizado por dolor abdominal en hipocondrio derecho de moderada intensidad asociado a ictericia, coluria, hipocolia, xeroftalmia, xerostomía y pérdida de peso de 3 kg. Al examen físico se evidencia ictericia, hipertrofia simétrica de glándulas submandibulares, leve dolor en epigastrio. En los exámenes auxiliares existe patrón colestásico con hiperbilirrubinemia a predominio directo. En los estudios de imágenes se evidencia colédoco dilatado, con aumento difuso del volumen del páncreas con captación tardía de contraste. En el estudio inmunológico se evidenció IgG4 en 610 u/L y ANA 1/640. Se inició tratamiento con corticoides con respuesta clínica y de laboratorio favorable. En conclusión, se debe sospechar de pancreatitis autoinmune ante un cuadro de dolor abdominal y colestasis extrahepática con imágenes sugestivas de páncreas inflamatorio, en el que se deben complementar los criterios ICDC para confirmar el diagnóstico

Autoimmune pancreatitis type 1 (AIP) is the pancreatic manifestation of IgG4-related disease. The most frequent presentation of AIP is with obstructive jaundice. For definite diagnosis of type 1 Autoimmune pancreatitis international consensus diagnosis criteria (ICDC) for AIP are used. ICDC criteria include pancreatic parenchymal imaging, ductal imaging, serology, other organ involvement, histology, and response to steroid. We report a 52-years-old woman with rheumatoid arthritis without treatment presented with two months of abdominal pain in up-right quadrant with moderate intensity. She also presented jaundice, acholia, xerophtalmia, xerostomia, and a weight loss of 5 pounds. On examination jaundice, symmetrically enlarged submandibular glands, and epigastric pain was observed. On laboratory, a cholestasis pattern and conjugated bilirubin predominance was found. CT Abdominal, CMR revealed a dilated common bile duct with a diffuse pancreatic enlargement with delayed enhancement. Immunological studies show a IgG4 610 u/l and ANA 1/640. The patient responds to steroid clinically and in the laboratorial values. In conclusion, autoimmune pancreatitis type 1 should be suspected in case of an obstructive jaundice with a pancreatic inflammatory image, and complete ICDC criteria for a definite diagnosis

An elicitation of utility for quality of life under prospect theory.

This paper performs several tests of decision analysis applied to the health domain. First, we conduct a test of the normative expected utility theory. Second, we investigate the possibility to elicit the more general prospect theory. We observe risk aversion for gains and losses and violations of expected utility. These results imply that mechanisms governing decisions in the health domain are similar to those in the monetary domain. However, we also report one important deviation: utility is universally concave for the health outcomes used in this study, in contrast to the commonly found S-shaped utility for monetary outcomes, with concave utility for gains and convex utility for losses.

Estimating sign-dependent societal preferences for quality of life.

This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off. There are also clear framing effects, which violate expected utility. Moreover, we observe loss aversion, indicating that subjects give more weight to one group's loss than another group's gain of the same absolute magnitude. We also elicited some information on the effect of the age of the studied group. The amount of inequity aversion is to some extent influenced by the age of the considered patients. In particular, more inequity aversion is observed for gains of older people than gains of younger people.

Simple preparation of new N-(6-methyl-2-nitrophenyl-1, 2, 3, 4-tetrahydroquinolin-4-yl) pyrrolidin-2-ones and their spectroscopic analysis / Preparação simples de novas N-(6-metil-2-nitrofenil-1, 2, 3, 4-tetrahydroquinoline-4-il) pirrolidin-2-onas e sua análise espectroscópica / Preparación simple de nuevas N-(6-metil-2-nitrofenil-1, 2, 3, 4-tetrahidroquinolin-4-il) pirrolidin-2-onas y su análisis espectroscópico

Preparación simple de nuevas N-(6-metil-2-nitrofenil-1,2,3,4-tetrahidroquinolin-4-il) pirrolidin-2-onas y su análisis espectroscópico. Objetivos. Preparar nuevas moléculas N-(1,2,3,4-tetrahidroquinolin-4-il) 2-oxopirrolidínicas y caracterizarlas por métodos espectroscópicos. Materiales y métodos. Todos los reactivos usados son de Aldrich, grado comercial. La pureza de los productos y la composición de las mezclas de reacción fueron monitoreadas por cromatografía en capa fina sobre cromatoplacas de Silufol UV254 (0.25 mm). El aislamiento y purificación se realizó usando cromatografía en columna (SiO2), usando acetato de etilo. Resultados. La preparación de las nuevas N-(tetrahidroquinolin-4-il) pirrolidin-2-onas 4-nitrofenil (ó 2-nitrofenil) sustituidas en C-2 del anillo tetrahidroquinolínico, se realizóvía síntesis one-pot basada en la reacción de cicloadición imino Diels-Alder catalizada por BiCl3 entre toluidina, N-vinilpirrolidin-2-ona y 4-nitrobenzaldehído (3-nitrobenzaldehído). La estructura de los derivados pirrolidónicos fue confirmada por 1H RMN y 13C RMN, además de experimentos 2D RMN y difracción de rayos X de monocristal. Conclusiones. Una ruta eficiente, económica y rápida (reacción imino Diels-Alder multi-componente) fue empleada para la construcción de nuevas moléculas N-(tetrahidroquinolin-4-il) 2-oxopirrolidínicas, esqueleto muy atractivo y usado con estereoquímica bien definida...

Objectives. To prepare new N-(1,2,3,4-tetrahydroquinolin-4-yl) pyrrolidin-2-one molecules and to characterize them by spectroscopic methods. Materials and methods. All reagents were purchased from Aldrich, commercial grade. The purity of the products and the composition of the reaction mixtures were monitored by thin layer chromatography over Silufol UV254 chromatoplates (0.25 mm). Product isolation and purification were performed by column chromatography (SiO2) using ethyl acetate. Results. Preparation of new N-(2-nitrophenyl-1,2,3,4-tetrahydroquinolin-4-yl) pyrrolidin-2-ones has been achieved via the one-pot synthesis, based on a BiCl3-catalyzedimino Diels-Alder cycloaddition reaction of toluidine, N-vinylpyrrolidin-2-one and 4-nitro- or 3-nitrobenzaldehydes. The structure of the pyrrolidine derivatives was confirmed by 1H nmr and 13C nmr studies, in addition to inverse-detected 2D NMR experiments and monocrystal X-ray diffraction. Conclusions. An efficient, economic, and fast synthetic route (multi-component imino Diels-Alder reaction) was employed in the construction of several new tetrahydroquinoline derivatives, useful and attractive rigid skeleton with well-defined stereochemistry...

Preparação simples de novas N-(6-metil-2-nitrofenil-1,2,3,4-tetrahydroquinoline-4-il) pirrolidin-2-onas e sua análise espectroscópica. Objetivos. Preparar novas moléculas N-(1,2,3,4-tetrahydroquinoline-4-il) 2-oxopirrolidínicas e sua caracterização por espectroscopia. Materiais e métodos. Todos os reagentes utilizados são de Aldrich, de grau comercial. A pureza dos produtos e a composição das misturas de reação foram monitoradas por cromatografia em camada fina sobre cromatoplacas de Silufol UV254 (0,25 mm). O isolamento e purificação foi realizado utilizando cromatografia em coluna (SiO2), utilizando acetato de etila. Resultados. Preparação de novas N-(tetrahydroquinoline-4-il) pirrolidin-2-onas 4-nitrofenil (ou 2-nitrofenil) substituídas em C-2 do anel tetrahydroquinoline foi realizada através da síntese “one pot” baseada na reação de cicloadição imino Diels-Alder catalisada por BiCl3 entre toluidina, N-vinilpirrolidin-2-ona e 4 nitrobenzaldehyde (3 nitrobenzaldehyde). A estrutura dos derivados pirrolidónicos foi confirmada por 1H RMN y 13C RMN, experimentos 2D RMN, assim como difração de raios X e monocristais. Conclusões. Uma rota eficiente, econômica e rápida (reação imino Diels-Alder multi-componente) foi utilizada para a construção de novas moléculas N-(tetrahydroquinoline-4-il) 2-oxopirrolidínicas esqueleto muito atraente e usado com estereoquímica bem definida...

Úlcera duodenal por citomegalovirus como causa de hemoragia digestiva alta en un paciente inmunocompetente / Duodenal ulcer due by cytomegalovirus as a cause of upper gastrointestinal bleeding in an immunecompetent patient

La úlcera duodenal por citomegalovirus (CMV) es muy poco frecuente en el paciente inmunocompetente. El presente caso es un adulto mayor con antecedente de infecciones urinarias a repetición que ingresa al hospital por historia de melena y vómitos tipo borra de café con hallazgos endoscópicos de úlcera duodenal y confirmación histopatológica de infección por citomegalovirus (CMV). Los estudios VIH, HTLV-1 y neoplasia oculta fueron negativos. El paciente presentó una evolución desfavorable falleciendo de shock séptico de origen urinario.

Duodenal ulcer due to cytomegalovirus (CMV) is quite infrequent in the inmunocompetent patient. We present an elderly patient with a history of upper urinary infections who wasadmitted at the hospital because of tarry black stool and coffee ground vomits. Endoscopy revealed duodenal ulcer and the histopathology confirm CMV infection. The workout was negative for human immunodeficient virus (HIV), HTLV-1 and occult cancer. The patient developed a serious infection and died due to urinary septic shock.

Enteritis eosinofílica como causa rara de ascitis: reporte de un caso / Eosinophilic enteritis as a rare cause of ascites: case report

Reportamos el caso de una mujer de 23 años de edad con historia de dolor epigástrico, tumoración palpable que abarca el epigastrio y el hipocondrio izquierdo y un episodio de pancreatitis aguda. La tomografía computarizada reveló un quiste pancreático. ElCA-125 se elevó notablemente. Se efectuó una laparotomía exploratoria encontrándose un endometrioma. La anatomía patológica mostró tejido necrótico, moco y sangre, conpresencia de macrófagos con fagocitosis de hemosiderina. Se discute el cuadro clínico, la patogénesis y el tratamiento de la endometriosis pancreática.

The case of a 23-year old woman with a history of epigastric pain, a palpable tumor that covered the epigastrium and the left hypochondrium, and an episode of acute pancreatitis was reported. The computerized tomography revealed a pancreatic cyst. The CA-125 increased significantly. An exploratory laparotomy was performed, finding an endometrioma. The pathological anatomy showed necrotic tissue, mucus and blood, with a presence of macrophages with hemosiderin phagocytosis. The symptoms and signs, pathogenesis and treatment of the endometriosis of the pancreas are discussed.

Evaluación económica de medicamentos: experiencias y vías de avance / Economic drug evaluation: experiences and pathways to progress

No disponible

[Prioritizing patients on waiting list for cataract surgery: preference differences among citizens]. / Priorización de pacientes en lista de espera para cirugía de cataratas: diferencias en las preferencias entre ciudadanos.

OBJECTIVES: To estimate and compare citizen preferences regarding patient prioritization for cataract surgery. METHOD: A conjoint analysis was performed. Priority criteria were identified and selected using 4 focus/nominal groups consisting of the general public, patients/relatives, allied health-professionals and specialists from Catalonia (n=36). Preferences elicitation (score of criteria): representative sample survey of the above mentioned groups (n=771) and rank-ordered logit model application. Differences were assessed by group analysis and their comparison. RESULTS: The criteria selected and their relative importance were: visual impairment (45%), difficulty in performing activities of daily living (ADL) (15%), limitation of ability to work (14%), being looked after by someone (11%), being a caregiver (8%), and recovery probability (7%). Differences in scores were observed among groups. Visual impairment was scored more highly by the general public and patients/relatives than by other groups (p<0.001). These two groups also assigned less importance to difficulty in performing ADL (p<0.001). The probability of recovery was the least scored criterion by most groups. Correlations among the order of hypothetical patient scenarios were high (r>0.9). However, the final order of patients on the waiting list could differ by up to 27 positions when different group scores were applied. CONCLUSIONS: Social and clinical criteria were considered important. The observed differences among citizens regarding how to prioritize patients on the waiting lists indicates the need to take into account the preferences of all groups of citizens.

[Prevalence of anti hepatitis C antibodies in patients with chronic renal failure receiving conservative therapy]. / Prevalencia de anticuerpos anti hepatitis C en pacientes con insuficiencia renal crónica en terapia conservadora.

UNLABELLED: The prevalence of hepatitis C varies according to geographical areas and risk groups. Patients with terminal chronic renal failure (TCRF) under dialysis are an important risk group. In Peru, hepatitis C virus (HCV) infection rates in patients under hemo-dialysis reach 90%, and are associated with transfusions and time under dialysis as risk factors. Little is known about the prevalence of HCV in patients with TCRF receiving non dialysis therapy. The purpose of this study is to know the prevalence of HCV infection in these patients and to determine the risk factors. METHODOLOGY: Prospective study, anti-hepatitis C (anti HCV) antibodies were assessed in patients with TCRF in non-dialysis conservative therapy at the Department of Nephrology of the Arzobispo Loayza Hospital. RESULTS: Ninety nine (99) patients were studied, 54.1% male and 45.8% female, with an average age of 56.6 + 17.9 years, with an average time of CRF diagnosis of 9.28 + 14.35 months. The most frequent cause of CRF was the unknown cause, followed by diabetes. A rate of anti HCV of 1.01% (1/99) was found. CONCLUSION: A low prevalence of antiHCV was found in the population studied. It was similar to the rates found in populations without CTRF.

Priorización de pacientes en lista de espera para cirugía de cataratas: diferencias en las preferencias entre ciudadanos / Prioritizing patients on waiting list for cataract surgery: preference differences among citizens

Objetivos: Estimar y comparar las preferencias de los ciudadanos sobre la priorización de pacientes en lista de espera para cirugía de cataratas. Método: Análisis de conjunto. Identificación y selección de criterios de priorización: 4 grupos focales/nominales de población general, pacientes/familiares, profesionales relacionados, y especialistas de Catalunya (n = 36). Estimación de las preferencias (puntuaciones de los criterios): entrevista a una muestra representativa de los 4 grupos (n = 771) y aplicación del modelo del rank-ordered logit. Las diferencias se estudiaron mediante análisis separado por grupo y su comparación. Resultados: Los criterios seleccionados y su importancia relativa fueron: incapacidad visual (45%), limitación de las actividades (15%), limitación para trabajar (14%), tener alguna persona que le cuide (11%), ser cuidador (8%) y probabilidad de recuperación (7%). Existieron diferencias entre grupos en la puntuación de los criterios. La población general y los pacientes/familiares valoraron más la incapacidad visual que los otros grupos (p 0,9), la ordenación final de éstos en la lista de espera podía variar hasta 27 posiciones al aplicar las preferencias obtenidas de un grupo o de otro. Conclusiones: Se consideró relevantes los criterios clínicos y los sociales. La existencia de diferencias sobre cómo deberían priorizarse los pacientes en espera recomienda tener en cuenta las preferencias de todas las partes afectadas

Objectives: To estimate and compare citizen preferences regarding patient prioritization for cataract surgery. Method: A conjoint analysis was performed. Priority criteria were identified and selected using 4 focus/nominal groups consisting of the general public, patients/relatives, allied health-professionals and specialists from Catalonia (n = 36). Preferences elicitation (score of criteria): representative sample survey of the above mentioned groups (n = 771) and rank-ordered logit model application. Differences were assessed by group analysis and their comparison. Results: The criteria selected and their relative importance were: visual impairment (45%), difficulty in performing activities of daily living (ADL) (15%), limitation of ability to work (14%), being looked after by someone (11%), being a caregiver (8%), and recovery probability (7%). Differences in scores were observed among groups. Visual impairment was scored more highly by the general public and patients/relatives than by other groups (p 0.9). However, the final order of patients on the waiting list could differ by up to 27 positions when different group scores were applied. Conclusions: Social and clinical criteria were considered important. The observed differences among citizens regarding how to prioritize patients on the waiting lists indicates the need to take into account the preferences of all groups of citizens

Prevalencia de anticuerpos anti hepatitis C en pacientes con insuficiencia renal crónica en terapia conservadora / Prevalence of anti hepatitis C antibodies in patients with chronic renal failure receiving conservative therapy

Introducción: La prevalencia de hepatitis C varía según el área geográfica y los grupos de riesgo. Los pacientes con insuficiencia renal crónica terminal (IRCT) en diálisis constituyen un grupo importante de riesgo. En el Perú las tasas de infección por el virus de la hepatitis C (HCB) en pacientes en hemodiálisis llegan hasta 90 por ciento, asociándose a las transfusiones y al tiempo en diálisis como factores de riesgo. Poco se sabe sobre la prevalencia de la infección por el HCV en pacientes con IRCT en terapia no dialítica. El objetivo de este estudio es conocer la prevalencia de la infección por HCV en estos pacientes y determinar los factores de riesgo. Metodología: Estudio prospectivo, se evaluaron los anticuerpos anti-hepatitis C (antiHCV), en los pacientes con IRCT en terapia conservadora, no dialítica, del Servicio de Nefrología del Hospital Arzobispo Loayza. Resultados: Se estudiaron 99 pacientes, 54.1 por ciento varones y 45.8 por ciento de mujeres, con una edad promedio de 56.60 más menos 17.9 años, con un tiempo de diagnóstico de IRC promedio de 9.28 más menos 14.35 meses. La causa más frecuente de IRC fue la no identificada seguida de la diabetes. Se halló una tasa de antiHCV de 1.01 por ciento (1/99). Conclusión: Se halló una prevalencia baja de antiHCV en la población estudiada, comparable con las tasas de la población general sin IRCT.

The prevalence of hepatitis C varies according to geographical areas and risk groups. Patients with terminal chronic renal failure (TCRF) under dialysis are an important risk group. In Peru, hepatitis C virus (HCV) infection rates in patients under hemodialysis reach 90 per cent, and are associated with transfusions and time under dialysis asrisk factors. Little is known about the prevalence of HCV in patients with TCRF receiving non dialysis therapy. The purpose of this study is to know the prevalence of HCV infection in these patients and to determine the risk factors. METHODOLOGY: Prospective study, anti-hepatitis C (anti HCV) antibodies were assessed in patients with TCRF in non-dialysis conservative therapy at the Department of Nephrology of the Arzobispo Loayza Hospital. RESULTS: Ninety nine (99) patients were studied, 54.1 per cent male and 45.8 per cent female, withan average age of 56.6 more 17.9 years, with an average time of CRF diagnosis of 9.28 more 14.35 months. The most frequent cause of CRF was the unknown cause, followed by diabetes. A rate of anti HCV of 1.01 per cent (1/99) was found. CONCLUSION: A low prevalence of antiHCV was found in the population studied. It was similar to the rates found in populations without CTRF.

[Medical errors in the continuous improvement of quality]. / Errores medicos en el mejoramiento continuo de la calidad.

The increase in medical errors during the last four decades of past centuries can be attributed to several causes: the human fallibility always present, concern in quality and continuity of physician-patient relationship and to the increased advance in technology innovation. These errors attract the attention of Agencies and Organizations involved in Healthcare Quality. From the work of these a series of recommendations were issued for the prevention of medical errors. The action level is a systemic one, due to the characteristic of the healthcare services.