A PRECEDE-PROCEED approach in the advocacy for computer-based education on correct medical certification of cause of death among physician-learners

Objective@#Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns. @*Methods@#An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification.@*Results@#Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines.@*Conclusion@#The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.

Development of fluorescent- and radio-traceable T1307-polymeric micelles as biomedical agents for cancer diagnosis: biodistribution on 4T1 tumor-bearing mice

Abstract In recent years, nanocarriers have been studied as promising pharmaceutical tools for controlled drug-delivery, treatment-efficacy follow-up and disease imaging. Among them, X-shaped amphiphilic polymeric micelles (Tetronic®, poloxamines) display great potential due to their biocompatibility and non-toxic effects, among others. In the present work, polymeric micelles based on the T1307 copolymer were initially decorated with a 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY)-fluorophore in order to determinate its in vivo biodistribution on 4T1 tumor-bearing mice. However, unfavorable results with this probe led to two different strategies. On the one hand, the BODIPY-micelle-loaded, L-T1307-BODIPY, and on the other hand, the 99mTc-micelle-radiolabeled, L-T1307- 99m Tc, were analyzed separately in vivo. The results indicated that T1307 accumulates mainly in the stomach, the kidneys, the lungs and the tumor, reaching the maximum organ-accumulation 2 hours after intravenous injection. Additionally, and according to the results obtained for L-T1307- 99m Tc, the capture of the polymeric micelles in organs could be observed up to 24 hours after injection. The results obtained in this work were promising towards the development of new radiotracer agents for breast cancer based on X-shaped polymeric micelles.

Prevención secundaria antitrombótica intensiva tardía luego de un infarto del miocardio ¿Cuándo, en quiénes y cómo? / Late intensive antithrombotic secondary prevention after myocardial infarction. When, in whom and how?

La probabilidad de nuevos eventos cardiovasculares mayores (ECVM) en pacientes luego de un infarto agudo del miocardio depende de diferentes variables, como el tiempo que haya pasado después del primer evento, el escenario de presentación (síndrome coronario agudo con/sin elevación del ST) y los factores de riesgo asociados. Dichos eventos se han relacionado con la respuesta proinflamatoria persistente1, la actividad plaquetaria y la actividad de la trombina2. La llegada de medicamentos con actividad antitrombótica más potente y específica en puntos clave del proceso trombótico ha permitido evaluar su efecto en el escenario de la prevención secundaria antitrombótica intensiva luego del primer año de un infarto del miocardio3. En este tipo de prevención se han propuesto diferentes estrategias terapéuticas, entre ellas se ha extendiendo la doble terapia antiplaquetaria (DTA) (4, iniciando terapias antiplaquetarias adicionales5, o usando dosis bajas de anticoagulantes directos más aspirina6. Sin embargo, las características similares y, a su vez, heterogéneas en esta población, generan dudas de cuándo, en quiénes y cómo usar este tipo de terapia.

A PRECEDE-PROCEED approach in the advocacy for computer-based education on correct medical certification of cause of death among physician-learners

Objective@#Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns.@*Methods@#An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification. @*Results@#Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines. @*Conclusion@#The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.

Granuloma gigantocelular de mandíbula en un niño de 6 años de edad: Reporte de un caso / Giant cell granuloma in the jaw in a 6-year-old child: A case report

El granuloma gigantocelular representa un tumor no odontogénico que se localiza por dentro del endostio de los maxilares (central) o en el periostio (periférico). Corresponde al 3-5 % de todas las lesiones benignas de los maxilares. Es más frecuente en niños y adultos jóvenes. Se presenta como un tumor de crecimiento lento y asintomático. Preferentemente, se ubica en la mandíbula, en la región de los incisivos, caninos y premolares. Se informa sobre un paciente de 6 años de edad que, conjuntamente con la extracción del premolar temporario inferior, presentó un tejido granulomatoso de crecimiento lento en la región premolar izquierda. La toma de la biopsia fue demostrativa para granuloma gigantocelular. Se realizó el tratamiento quirúrgico, con buena evolución, sin evidencia de recidiva hasta la actualidad. Es importante el diagnóstico temprano de esta lesión por el alto poder destructivo local que presenta y la derivación oportuna para el tratamiento quirúrgico.

Giant cell granuloma represents a non-odontogenic tumor. It is located inside the endosteum of the jaws (central) or in the periosteum (peripheral). Although it is a benign disease process, it can also be locally destructive. This condition is a slow-growing, asymptomatic lesion that usually affects children and young adults, predominantly females in its peripheral presentation and males in its central presentation. The mandible, the region of the incisors, canines and premolars are more affected. The etiology of the giant cell granuloma still remains to be defined. It has been reported that the origin of this lesion could be triggered by trauma or inflammation and hormonal factors. A 6-year-old patient presents a slow-growing lesion in the tooth extraction's region, two months ago. The treatment is surgical. It is important to have an early diagnosis because of the high local destructive behavior and timely referral because the treatment is surgical.

Síndrome de Melkersson-Rosenthal: Presentación de dos casos pediátricos / Melkersson Rosenthal syndrome: Report of two pediatric cases

El síndrome de Melkersson-Rosenthal es una enfermedad muy poco frecuente en el paciente adulto y excepcional en la niñez y la adolescencia. El reciente trabajo publicado por G. Kayabasoglu et al., afirma que solo 30 pacientes se han descrito en la literatura internacional en edad pediátrica. Es de etiología desconocida, de curso crónico y progresivo, con compromiso neuromucocutáneo que afecta la inervación orofacial con infiltración granulomatosa no caseificante. Clínicamente, se caracteriza por una tríada diagnóstica: edema recurrente de labios y/o cara, parálisis facial periférica aguda recurrente y alternante, y lengua escrotal o geográfica. Existen presentaciones oligosintomáticas y monosintomáticas. Se describen dos pacientes de 7 y 11 años de edad, con presentación completa en un caso y oligosintomática en el otro. Consideramos tener en cuenta esta enfermedad infrecuente como diagnóstico diferencial ante la presencia de parálisis facial periférica aguda recurrente y/o edema de hemicara o labios por su comportamiento evolutivo.

Melkersson Rosenthal syndrome is a very infrequent disease of unknown etiology, chronic and progressive course, with neurocutaneous disease that affects the orofacial innervation and mucocutaneous tissues with non-caseating granulomatous infiltration. Clinically, it is characterized by the diagnostic triad: recurrent edema of lips and/or face; recurrent and alternating acute peripheral facial paralysis and scrotal or geographic tongue. The condition generally presents as oligosymptomatic or monosymptomatic form. Two patients are presented with completed triad and oligosymptomatic form. This recent review published by G. Kayabasoglu et al. states that only 30 patients have been described in the international literature in childhood. So we consider this disease in the differential diagnosis in the presence of acute peripheral facial paralysis and/or lips or facial edema.

Real-time regular routine reporting for health (R4Health): Lessons from the implementation of a large scale mobile health system for routine health services in the Philippines

BACKGROUND: The Philippine government aims for a modern information system to enhance data quality and provide more rational evidence to support timely and efficient delivery of health care, management of health systems, programs and policy. Hence, the Real-time Regular Routine Reporting for Health (R4Health) mHealth application was developed and field tested in 246 isolated and disadvantaged municipalities to support the campaign for Universal Health Care and the achievement of the Millennium Development Goals. The R4Health collected point-of-care-specific data on services routinely provided at the rural health facilities, aggregated them and presented in a dashboard for use by program managers and policy makers. OBJECTIVE: This paper describes the use of R4Health, a mobile technology-based health reporting system. It will discuss the context of the R4Health implementation, its development and deployment to 246 municipalities in the Philippines. Furthermore, the paper sought to determine enablers and challenges to the adoption of R4Health in routine health care. METHODS: Data was collected through surveys, focus group discussions, participant-observation and review of project reports. Quantitative data was summarized using descriptive statistical methods; qualitative data underwent content analysis.    RESULTS AND CONCLUSION: A total of 515,855 R4Health reports equivalent to 48,856 patient transactions were received from 246 municipalities within a nine-month observation period, supporting the viability of the R4Health as an alternative option to the existing manual and paper based health information management to improve the quality of data. R4Health utilizes a tool that everyone is familiar with, can easily be incorporated in their workflow, can be brought and used anywhere and has an application that is clear, understandable, and easy to learn and use. R4Health data elements, however, have overlaps with other government health reporting systems and is already misconstrued to further duplicate work. More discussions are warranted to coordinate and integrate systems. Given the general positive perspectives, integration of this alternative system to the RHU workflow, an improved R4Health, has a high potential of being accepted and adopted by the first-line health workers across the country. 

Community health information and tracking system (CHITS): Lessons from eight years implementation of a pioneer electronic medical record system in the Philippines

The CHITS (Community Health Information and Tracking System), the first electronic medical record system in the Philippines that is used widely, has persevered through time and slowly extended its geographic footprint, even without a national policy. This study describes the process of CHITS development, its enabling factors and challenges affecting its adoption, and its continuing use and expansion through eight years of implementation (2004 to 2012) using the HOT-fit model. This paper used a case study approach. CHITS was developed through a collaborative and participative user-centric strategies. Increased efficiency, improved data quality, streamlined records management and improved morale among government health workers are benefits attributed to CHITS. Its longevity and expansion through peer and local policy adoption speaks of an eHealth technology built for and by the people. While computerization has been adapted by an increasing number of local governments, needs of end-users, program managers and policy-makers continue to evolve. Challenges in keeping CHITS technically robust, up-to-date and scalable are already encountered. Lack of standards hampers meaningful data exchange and use across different information systems. Infrastructure for electricity and connectivity especially in the countryside must be established more urgently to meet over-all development goals specially. Policy and operational gaps identified in this study have to be addressed using people-centric perspective and participatory strategies with the urgency to achieve universal health care. Further rigorous research studies need be done to evaluate CHITS' effects on public health program management, and on clinical outcomes.

Formulating the national policy on telehealth for the Philippines through stakeholders' involvement and partnership

The Philippine Department of Health (DOH) recognized the potentials of information and communication technology (ICT) as a valuable aid to achieve Kalusugan Pangkalahatan (KP) or Universal Health Care for all Filipinos. In 2011, the Development of the National Telehealth Service Program (NTSP) in the DOH Project was proposed and implemented as a collaborative and developmental project of the DOH, with the University of the Philippines-Manila through the National Telehealth Center. The Project defined operational and policy issues critical in incorporating telehealth as a standard program, service delivery and information management mode in the DOH. To sustain this beyond the current Project financing and political leadership, as well as to provide a policy framework to guide the implementation of telehealth in the country, a DOH administrative order (AO) was proposed. Stakeholder feedback was sought to surface views and concerns to ensure better relevance and effective policy implementation. Four public fora were held from 2012 to 2014 participated in by 241 individuals from the national agencies and local governments, project implementers, academe, and the private sector. General comments centered on governance and ensuring representation by patient advocate groups and the local governments. Capacity building and financing of telehealth, and regulation especially with regards to ethical use and protection of patients' privacy were prominent concerns. Participants affirm the preference for the poor and marginalized, although envision that telehealth and digital health information systems should be standard components of health care in the country. Other comments were specific to telemedicine and using mobile phones to report on health services from the frontline clinics. Recommendations are presented.

Elaborating and discoursing the ethics in eHealth in the Philippines: Recommendations for health care practice and research

OBJECTIVES: The objectives of the research study were to determine ethical guidelines and principles applicable in the practice and research of eHealth and telehealth in the Philippines, how these are applicable to the Philippines, and to differentiate between the ethical issues in research and in clinical practice of eHealth. METHODS: This research study used: 1) review of ethics manuscripts, guidelines and literature; 2) focused group discussion and key informant interviews of experts; and 3) triangulation. The information sought for the review were- 1) relevant policies, guidelines in eHealth that are pertinent to the discussion of eHealth ethics in the Philippines; 2) components of ethics in eHealth research; and 3) components of ethics in eHealth practice. The framework of the consultation with experts was to identify mechanisms and strategies in incorporating ethics in both eHealthpractice and eHealth research within the following- 1) in reference to existing laws, policies, and guidelines on ethics in medicine and health; and 2) in the context of the Philippine setting. RESULTS: Based on the review, there are pertinent codes of ethics, applicable laws, policies and guidelines in eHealth, both in the international and local settings. The focus group discussion and key informant interview with experts yielded significant and deeper understanding on how to address the gaps and lapses of ethics applied to eHealth in the country. These recommendations were given which distinguish between the ethics in clinical practice and ethics in the planning and implementation of eHealth systems. There is also a need to resolve the problem of whose primary responsibility the patient is- the referring, commonly referred to as the attending physician in the local community, or the specialist from the center. The proposed resolution was also presented. CONCLUSION: The study has shown how important eHealth in potentially promoting timely and improved health care access. However, there are still lapses and gaps in the implementation of policies and guidelines on and relating to eHealth in the Philippines as shown by the data culled from the review and the focus group discussions with the experts. With more specific ethical guidelines and relevant policies, the development and practice of eHealth and telehealth will be on its way in bridging the gap and aiding in health systems development in the Philippines, especially with the support of the national government and collaboration of various agencies and stakeholders.

The Philippine policy context for eHealth

BACKGROUND: eHealth in the Philippines is poised to take off but adoption of eHealth applications in the country's public health sector is limited in scale. OBJECTIVE: This paper examines the context and status of eHealth policy in the Philippines. The aim is to lay out the domains of policy issues that should be addressed for the successful implementation of eHealth in the Philippines. METHODS: The themes and issues of policies on eHealth cited by Khoja, Durrani, Nayani and Fahim (2012) were used to describe and analyze the status of eHealth policy context in the Philippines. These are: (1) networked care, (2) interjurisdictional practice, (3) diffusion of eHealth/digital divide, (4) eHealth integration with existing systems, (5) response to new initiatives, (6) goal-setting for eHealth policy, (7) evaluation and research, (8) investment, and (9) ethics in eHealth. Documents and policies in the form of enacted laws, memoranda, implementing rules and regulations were retrieved and reviewed to answer whether or not policy themes and issues are addressed currently. RESULTS AND CONCLUSION: Current policies in the status quo do not adequately address the issues that enable effective implementation of eHealth in the Philippines. While preconditions for eHealth to flourish such as strategic frameworks for ICT and eHealth have been established, they are inadequate in addressing licensing, diffusion of innovation, handling innovation, evaluation and research, and investment.

Rehabilitación cardiovascular y ejercicio en prevención secundaria / Exercise and cardiac rehabilitation in secondary cardiovascular prevention

Exercise and cardiac rehabilitation are indications with type I A evidence in most secondary cardiovascular prevention guidelines. Rehabilitation programs not only include exercise but also provide integral care and education about cardiovascular risk factors. However there is a paucity of such programs in Chile. Moreover there is a lack of awareness about the benefits of exercise and there is lack of knowledge about the details of exercise prescription in secondary prevention. Therefore, the divulgation of this knowledge is of utmost importance.

Atención estomatológica en la población pediátrica del Hospital General de Niños Pedro de Elizalde (HGNPE). Período enero de 2000 a junio de 2010 / Dental care in the pediatric population of the Hospital General de Niños Pedro de Elizalde (HGNPE). Period january 2000 to june 2010

Introducción. Las lesiones en cavidad oral representan un amplio espectro de afecciones: variaciones anómalas y del desarrollo; microtraumas; lesiones por agentes físicos, químicos; infectocontagiosas; inmunoalérgicas; enfermedades sistémicas; desórdenes nutricionales y tumorales. Objetivo. Presentar la experiencia de la atención estomatológica en la población pediátrica, en 10 años de trabajo interdisciplinario. Diseño. Estudio retrospectivo, descriptivo, corte transversal. Material y método. Revisamos, historias clínicas estomatológicas, período enero de 2000 a junio de 2010. Consideramos como variables de estudio edad; sexo; antecedentes personales; familiares; lesiones elementales; localización; síntomas y hallazgos patológicos en estudios complementarios. Expresamos los resultados en promedios y porcentajes. Resultados. Consignamos 499 pacientes; 221 (47,02%) masculinos y 277 (58,94%) femeninos; en un paciente no se consignó sexo. Agrupamos las patologías, en un intento de clasificación, por lesiones elementales; encontramos: 264 casos de tumores (52,91%); 58 vegetación, verrugosidad (11,62%); 55 pérdidas de sustancia (11,02%); 49 vesículas, ampollas (9,82%); 48 manchas, pseudomanchas (9,62%); 21 hiperplasia, hipertrofia (4,21%), 4 otras patologías (0,80%). Localizaciones preferentes: labio inferior, lengua, piso de boca, paladar, bermellón; mucosa yugal y labio superior. Conclusión. Encontramos predominio en sexo femenino; la patología tumoral fue la más frecuente, representada en especial por el mucocele. Consideramos que el eje de la prevención estomatológica en la población pediátrica, es el diagnóstico temprano; el examen de la cavidad oral debe ser sistemático; el manejo de las patologías en interdisciplina es lo más adecuado.

Introduction. Oral cavity lesions, representing a broad spectrum of conditions: abnormal variations and development; microtrauma; injury by physical, chemical, infectious, immuno, systemic diseases, nutritional disorders and tumor. Objective. Present experience dental care in the pediatric population, in 10 years of interdisciplinary work. Design. A retrospective, descriptive, crosssectional. Materials and methods. We review, dental records, period in January 2000, June 2010. We consider study variables age, sex, medical history, family, elementary lesions, location, symptoms and pathological findings in further studies. We express the results in averages and percentages. Results. Consign 499 patients, 221 (47.02%) male and 277 (58.94%) female, in a patient sex was not recorded. Pathologies grouped in an attempt classification, by elementary lesions; found: 264 tumor cases (52.91%); 58 vegetation warty (11.62%) loss of substance 55 (11.02%); 49 vesicles, blisters (9.82%), 48 spots, pseudomanchas (9.62%), 21 hyperplasia, hypertrophy (4.21%), 4 other pathologies (0.80%). Preferential localization: lower lip, tongue, floor of mouth, palate, vermilion, buccal mucosa and upper lip. Conclusion. Found predominantly in females, the disease was the most frequent tumor, represented especially by the mucocele. We believe that the axis of dental prevention in the pediatric population is early diagnosis, the oral cavity examination should be systematic, management of diseases in interdisciplinary is most appropriate.

Marcado con 99m de liposomas convencionales y su evaluación biológica / 99mTc-labeling and biological evaluation of conventional liposomes

Introducción. Los liposomas son sistemas supramoleculares autoensamblables preparados ad hoc, compuestos de fosfolípidos y colesterol, diseñados para transporte de fármacos o radionucleidos. El 99mTc es el radionucleido más empleado por sus propiedades físicas apropiadas para la adquisición de imágenes y estudios en pacientes en el área de medicina nuclear (emisor gamma puro con E = 140 KeV , t1/2 = 6 horas). Objetivo. Evaluar la potencialidad de liposomas convencionales marcados con 99mTc como agente de diagnóstico de procesos tumorales. Método. La composición estudiada es: fosfatidilcolina, dioleilfosfatidiletanolamina y colesterol (1.1:0.4:1 relación molar). Se utilizó como agente reductor SnF2, en diferentes cantidades para optimizar el marcado. La pureza radioquímica y eficiencia de marcado se evaluaron con sistemas cromatográficos ITLC-SG FM NaCl 0,9 por ciento, ITLC-SG FM Piridina:ácido acético:agua (3:5:1.5 v/v). Se adquirieron imágenes a 1 h post inyección de los liposomas en ratones sanos y portadores de tumor mamario espontáneo. Resultados. El liposoma marcado mostró estabilidad durante 24 h, siendo la cantidad óptima de reductor 138 ug. La mejor captación en tumor fue a 1 h post administración del radiofármaco en los estudios centellográficos. Conclusiones. El método optimizado permite obtener liposomas marcados con 99mTc en forma sencilla, eficiente y estable. Estos radiofármacos mostraron un comportamiento fiscoquímico y biológico adecuado como agentes de diagnóstico tumoral requiriéndose estudios posteriores para su confirmación.

Background. Liposomes are self-assembled supramolecular systems, composed by phospholipids and cholesterol, designed for the transportation of drugs or radionuclides. Physical properties of 99mTc (pure gamma emitter with E = 140 KeV, t1/2= 6 hours) makes it useful for scintigraphic imaging. Purpose. The goal of this study was to evaluate 99mTc labeled conventional liposomes as potential diagnostic agents for malignant lesions. Methods. The studied liposome composition was hosphatidylcholine: dioleilphosphatidylcholine: cholesterol (1.1:0.4:1molar rate). In order to optimize the labeling, SnF2 was used as reducing agent. Radiochemical purity and labeling efficiency were evaluated using ascending thin layer chromatography. Scintigraphy images were obtained at 1 hour post-injection of labeled liposomes to healthy mice and with spontaneous breast tumors. Results. Labeled liposomes showed stability during 24 hours, being 138 ug the optimal amount of reducing agent for the technique used. Conclusions. The described method allows the production of 99mTc labeled liposomes in a simple, efficient and stable way. The radiopharmaceutical showed a physicochemical and biological behavior that allows its potential use as a tumor imaging agent, although further studies are required to confirm this issue.

Actividad física y potencia aeróbica: ¿Cómo influyen sobre los factores de riesgo cardiovascular clásicos y emergentes? / Association between cardiorespiratory fitness and cardiovascular risk factors in healthy individuals

Background: Cardio respiratory fitness (FIT) is associated with a better profile in most modifiable cardiovascular risk factors (RF). In Chile, sedentary lifestyle is highly prevalent, reaching almost 90 percent. Aim: To determine the association between FIT and traditional and emergent RF in a primary prevention population. Material and methods: We prospectively studied 1973 subjects (36 percent women, mean age 56± 13 years) without history of cardiovascular disease and absence of ischemic changes on exercise testing. We assessed cardiovascular RF and determined body mass index (BMI), waist circumference, systolic and diastolic blood pressure, fasting blood lipids, glucose, C-reactive protein (CRP) and fibrinogen. FIT was measured by a Sci f-reported physical activity questionnaire and by a maximal treadmill exercise test, expressed in metabolic equivalents (METs). Results: Subjects in the highest FIT according to the treadmill test had significantly lower BMI, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, glucose, CRP and fibrinogen, and higher HDL cholesterol (adjusted by age and gender). LDL cholesterol did not show significant changes. The same pattern of RF (including LDL cholesterol) and CRP was observed when using Sci f-reported physical activity as a FIT parameter There was a significant association between both methods to measure FIT (p <0.0001, Chi-square Mantel-Haenszel). Conclusions: Our findings show that a better level off IT, assessed by exercise testing or through Sci f report is associated with improved levels of traditional and emergent RF.

Unidad de dolor torácico: primera experiencia en Chile / Chest pain unit: first experience in Chile

Background: In large series, nearly 60 percent of admissions for suspected acute coronary syndrome (ACS) had a non-coronary etiology of the pain. However, short term mortality of non recognized ACS patients, mistakenly discharged from the emergency room is at least twice greater than the expected if they would had been admitted. The concept of a chest pain unit (CPU) is a methodological approach developed to address these issues. Aim: To evaluate the efficacy of a CPU in the emergency room of a general hospital for evaluation of acute chest pain. Material and Methods: Prospective study of patients with chest pain admitted in the CPU. After a clinical, electrocardiographic and laboratory evaluation with cardiac injury serum markers, patients were stratified in three risk groups, based on the likelihood of ACS of the American Heart Association. High probability patients were admitted to the Coronary Unit (CU) for treatment. Moderate probability patients remained in the CPU for further evaluation and low probability patients were discharged with telephonic follow-up. Results: Of 407 patients, 35, 30 and 35 percent were stratified as high, intermediate and low probability ACS, respectively. Among patients admitted with high probability, 73 percent had a confirmed ACS diagnosis. Among intermediate probability patients, 86 percent were discharged after an evaluation in the CPU without adverse events in the follow-up. Conclusion: Structured risk evaluation approach in a CPU improves the management of acute chest pain, identifying high probability patients for fast admission and start of treatment in a CU and allowing safe discharge of low probability ones.

Investigaçäo das doenças pulmonares na síndrome de imunodeficiência adquirida: uma revisäo / Pulmonary diseases investigation in acquired immunodeficiency syndrome: a review

Os autores descrevem as principais doenças pulmonares no paciente com a Síndrome de Imunodeficiência Adquirida, além de uma rotina diagnóstica e de acompanhamento destas manifestaçöes