Comparing the outcomes and costs of cardiac monitoring with implantable loop recorders and mobile cardiac outpatient telemetry following stroke using real-world evidence.

Aim: Patients with ischemic stroke (IS) commonly undergo monitoring to identify atrial fibrillation with mobile cardiac outpatient telemetry (MCOT) or implantable loop recorders (ILRs). The authors compared readmission, healthcare cost and survival in patients monitored post-stroke with either MCOT or ILR. Materials & methods: The authors used claims data from Optum's de-identified Clinformatics® Data Mart Database to identify patients with IS hospitalized from January 2017 to December 2020 who were prescribed ambulatory cardiac monitoring via MCOT or ILR. They compared the costs associated with the initial inpatient visit as well as the rate and causes of readmission, survival and healthcare costs over the following 18 months. Datasets were balanced using patient baseline and hospitalization characteristics. Multivariable generalized linear gamma regression was used for cost comparisons. Cox proportional hazard regression was used for survival and readmission analysis. Sub-cohorts were analyzed based on the severity of the index IS. Results: In 2244 patients, readmissions were significantly lower in the MCOT monitored group (30.2%) compared with the ILR group (35.4%) (hazard ratio [HR] 1.23; 95% CI: 1.04-1.46). Average cost over 18 months starting with the index IS was $27,429 (USD) lower in the MCOT group (95% CI: $22,353-$32,633). Survival difference bordered on statistical significance and trended to lower mortality in MCOT (8.9%) versus ILR (11.3%) (HR 1.30; 95% CI: 1:00-1.69), led by significance in patients with complications or comorbidities with the index event (MCOT 7.5%, ILR 11.5%; HR 1.62; 95% CI: 1.11-2.36). Conclusion: The use of MCOT versus ILR as the primary monitor following IS was associated with significant decreases in readmission, lower costs for the initial IS and total care over the next 18 months, significantly lower mortality for patients with complications and comorbidities at the index stroke, and a trend toward improved survival across all patients.

Impact of surgical complications on hospital costs and revenues: retrospective database study of Medicare claims.

Aim: To compare the length of stay, hospital costs and hospital revenues for Medicare patients with and without a subset of potentially preventable postoperative complications after major noncardiac surgery. Materials & methods: Retrospective data analysis using the Medicare Standard Analytical Files, Limited Data Set, 5% inpatient claims files for years 2016-2020. Results: In 74,103 claims selected for analysis, 71,467 claims had no complications and 2636 had one or more complications of interest. Claims with complications had significantly longer length of hospital stay (12.41 vs 3.95 days, p < 0.01), increased payments to the provider ($34,664 vs $16,641, p < 0.01) and substantially higher estimates of provider cost ($39,357 vs $16,158, p < 0.01) compared with claims without complications. This results on average in a negative difference between payments and costs for patients with complications compared with a positive difference for claims without complications (-$4693 vs $483, p < 0.01). Results were consistent across three different cost estimation methods used in the study. Conclusion: Compared with patients without postoperative complications, patients developing complications stay longer in the hospital and incur increased costs that outpace the increase in received payments. Complications are therefore costly to providers and payers, may negatively impact hospital profitability, and decrease the quality of life of patients. Quality initiatives aimed at reducing complications can be immensely valuable for both improving patient outcomes and hospital finances.

Neurofibromatosis tipo I y Síndrome de Klippel-Trenaunay / Neurofibromatosis type I and Klippel–Trénaunay Syndrome

Se presenta un caso de asociación entre dos enfermedades que afectan la piel y otros órganos: Neurofibromatosis tipo I y Síndrome de Klippel-Trenaunay. El hecho se considera una rareza y se diagnosticó en un adolescente de 13 años de edad con el antecedente de Neurofibromatosis tipo I. El paciente es llevado a la consulta externa de Dermatología por aumento de volumen del muslo Izquierdo, lo que hizo sospechar una lesión vascular subyacente a la zona névica, confirmándose tras estudios la coexistencia con un Síndrome de Klippel-Trenaunay, motivando a la presentación del caso por la poca frecuencia de asociación de estas enfermedades. Se resalta la importancia del asesoramiento genético, diagnóstico precoz y seguimiento de los pacientes afectados, dada la posible repercusión en otros órganos vitales (AU)

The study presents a case of association between two diseases that affect the skin and other organs: neurofibromatosis type I (NF-1) and Klippel–Trénaunay syndrome (KTS). It is considered a rare medical condition. It was diagnosed in an adolescent of 13 years of age with a history of neurofibromatosis type I, who was taken to the dermatology department with a volume increase of the left thigh and suffering from a suspected vascular lesion underlying the nevus area. After several studies the coexistence with a Klippel–Trénaunay syndrome was confirmed what motivated the presentation of the case due to the limited frequency of association between these diseases. The importance of the genetic advice is emphasized, as well as the early diagnosis and the follow-up care of the affected patients, taking into account the possible repercussion on other vital organs (AU)

Motivación por la Morfofisiología y su repercusión en los resultados académicos / Attitude toward Morphophysiology and its impact on academic results

Fundamento: los resultados académicos en la asignatura Morfofisiología I, en el momento de la investigación, manifestaban un descenso con respecto a cursos anteriores.Objetivo: describir aspectos de la motivación por la Morfofisiología I y su probable relación con el rendimiento académico, en alumnos del primer año de la carrera de Medicina, del policlínico universitario Románico Oro de Puerto Padre, durante el primer semestre del curso 2015-2016.Métodos: se realizó un estudio descriptivo, observacional, de corte transversal, con los alumnos antes referidos, 94 en total. Se les aplicó un cuestionario anónimo y se revisaron informes de promoción y otros documentos del colectivo de la asignatura. Para el procesamiento de los datos se utilizó la estadística descriptiva.Resultados: el 56,4 por ciento de los estudiantes se consideró de bajo rendimiento; de ellos el 50 por ciento refirieron motivación regular por la asignatura, mientras que el 42,6 por ciento de los de alto rendimiento refirieron mucha motivación; el 52,3 por ciento de los estudiantes de bajo rendimiento muestran desagrado por la asignatura y el 53,2 por ciento no previeron las dificultades; el 40,4 por ciento de los estudiantes muestran la mayor preferencia por la asignatura Medicina General Integral.Conclusiones: predominaron los estudiantes con bajo rendimiento académico, lo que pudiera deberse a diferentes variables relacionadas con la motivación (AU)

Background: the academic results of Morphophysiology I, at the time of the research, had a decrease regarding previous academic years.Objectives: to describe aspects of the students attitude toward Morphophysiology I and its probable relation to the academic performance of 1st-year-medical students of Romárico Oro Teaching Polyclinic of Puerto Padre, during the first semester of the academic year 2015-2016.Methods: a descriptive, observational and cross-sectional study was carried out with the students herein mentioned for a total of 94. The students were given an anonymous questionnaire, the graduation records were checked and the documents of subject staff were inspected. For data processing descriptive statistics was used.Results: 56,4 percent of the students showed a low performance. 50 percent of them said to have a regular attitude toward the subject, while 42,6 percent of high-performance students stated to have a high attitude. 52,3 percent of low-performance students showed dislike for the subject and 53,2 percent did not anticipate the difficulties. 40,4percent of the students showed the greatest preference for the subject Family Medicine.Conclusions: Low-performance students prevailed what could be related to the attitude toward the subject (AU)

Manifestaciones dermatológicas en pacientes con VIH/SIDA / Dermatological manifestations in patients with HIV/AIDS

Dada la alta frecuencia de manifestaciones dermatológicas en pacientes con VIH/SIDA y con el objetivo de describir su comportamiento en nuestro territorio, se realizó una investigación observacional descriptiva de corte transversal, en los casos de la consulta provincial de SIDA del Hospital General Docente Ernesto Guevara de Las Tunas, desde enero de 2007 hasta junio de 2008. Los datos se obtuvieron de la encuesta y el examen dermatológico, así como de las historias clínicas. La muestra estuvo representada por 43 pacientes, predominando el sexo masculino y el grupo de edad de 31 a 40 años. No existieron diferencias cuantitativas importantes entre el número de seropositivos y el de casos con SIDA. El 27,9 por ciento presentó dermatosis, lo que hizo sospechar de la presencia de la retrovirosis crónica. Las enfermedades virales seguidas de las micóticas se destacaron como las más frecuentes, encontrándose como las de menor aparición las de tipo neoplásico y por reacciones a medicamentos. Otras infecciones de transmisión sexual (ITS) aparecieron asociadas a la enfermedad de base, principalmente el herpes simple tipo II y los condilomas acuminados (AU)

In view of the frequency of the dermatological manifestations in patients who suffer from AIDS/HIV, and with the objective of describing their behaviour, a descriptive, observational, and cross sectional investigation was carried out in the cases of the AIDS provincial consultation at Ernesto Guevara General Teaching Hospital of Las Tunas from January, 2007 to June, 2008. The information was obtained from the survey, the dermatological examination, and the clinical charts. The sample was made up of 43 patients, in which males and 31 to 40 age groups prevailed. There were no important quantity differences between the seropositive number and AIDS cases. The 27, 9 per cent had dermatosis that made suspect the presence of the chronic retrovirus. The viral and the mycotic diseases were the most frequent ones, being the neoplastic type and drug reactions the least frequent ones. Other sexually transmitted diseases (STD) appeared associated to the primary disease, mainly herpes simplex type II, and verruca acuminate (AU)

Reacciones adversas de antimicrobianos en gestantes hospitalizadas / Adverse reactions to antimicrobials in hospitalised pregnant women

Se realizó un estudio descriptivo del comportamiento de las reacciones adversas de los antimicrobianos utilizados en las gestantes hospitalizadas en las salas E-2 y F-2 del Hospital “Ernesto Guevara“de la ciudad de Las Tunas, en el período comprendido de enero a julio del 2002. Se les llenó a cada paciente un modelo de recogida de datos y se revisaron sus historias clínicas, confirmando los datos obtenidos en la entrevista con el médico. Se produjeron un total de 136 reacciones adversas a 8 antimicrobianos, para una incidencia de l 65 por ciento, los fármacos más prescriptos fueron el clotrimazol en tabletas vaginales, el metronidazol oral y la gentamicina en ámpulas. La enfermedad infecciosa más frecuente fue la sepsis vaginal, predominaron las reacciones adversas a nivel del tracto gastrointestinal. Los antimicrobianos según categoría de riesgo pertenecen a la categoría B. Analizando la severidad de las reacciones predominó la intensidad moderada con una relación de causalidad probable(AU)

A descriptive, study about the behavior of the adverse reactions of the antimicrobials used in hospitalized pregnant women in wards E-2 and F-2 was carried out at “Ernesto Guevara” Hospital in Las Tunas, from January to July 2002. The data was recorded in a form and the clinical charts were checked to confirm the information obtained by means of the doctors interview. A total of 136 adverse reactions to 8 antimicrobials were produced for an incidence of 65 per cent. The drugs prescribed the most were clotrimazole (vaginal tablets), metronidazole (oral) and gentamicine (ampoules), vaginal sepsis was the most frequent infection disease with a prevalence of adverse reactions in the gastrointestinal tract. The antimicrobials used according to risk categories belong to Category B. Being analyzed the severity of reactions the moderate intensity was the predominant in relation to the probable causality(AU)

Resistencia a drogas mediada por la glicoproteína P / P-glycoprotein-mediated resistance to drug

A pesar de los logros alcanzados en la quimioterapia de las enfermedades malignas, la resistencia a citotóxicos constituye un gran obstáculo para la curación de los pacientes. Se han identificado varios genes, proteínas y vías metabólicas implicados en este fenómeno. Hasta el momento el más estudiado es el gen mdr 1 y su producto, la glicoproteína p, que actúa como una bomba extractora dependiente de energía; se ha demostrado en tejidos normales vinculados con funciones secretoras o de barrera, así como en neoplasias humanas, donde provoca un fenotipo de resistencia simultánea a múltiples drogas. El aumento en la expresión del gen mdr 1, se señala como un factor pronóstico adverso en leucemias, linformas y algunos tumores sólidos. La importancia clínica de este hecho ha llevado a múltiples estrategias para evitar o revertir los efectos de la resistencia a las drogas antineoplásicas(AU)