ABSTRACT
Resumen: Se describe el desarrollo del Hospital Regional de Tacuarembó (HRT), situado en una ciudad mediana del norte de Uruguay, que lo condujo a convertirse en un referente dinamizador de la salud regional, con una atención médica moderna y eficaz, así como de servicio a la comunidad y a la salud nacional. Todo ello logrado a través de una gestión ambiciosa y optimista en los objetivos, basada en esfuerzos colectivos e individuales así como en apoyos institucionales nacionales y de organismos internacionales. Ese papel dinamizador e influyente a nivel regional, e inclusive nacional, está basado, por una parte, en una gran mejora de su base logística, es decir, el propio hospital, en cuanto a instalaciones, equipamientos y ampliación de las capacidades de atención médica; pero también en un gran apoyo e impulso a la Atención Primaria en Salud, no solo en la ciudad de Tacuarembó, sino a nivel departamental. Además, el HRT ha jugado un papel importante en el control de dos zoonosis parasitarias de importancia nacional: la enfermedad de Chagas y la equinococosis quística. Esa acción dinamizadora ha consistido en plantear al hospital como una "organización de salud", considerando el contexto de un territorio particular junto a los determinantes del sistema nacional de salud. Se puede considerar al HRT como una organización innovadora liderada por "emprendedores sociales" dentro de un marco de emprendimiento social partiendo de un hospital departamental o provincial.
Summary: The study presents the case of the Hospital de Tacuarembó (HRT), located in a medium-size city in the north of Uruguay, which turned into a reference in terms of the dynamization of regional health, offering modern and effective healthcare services, serving the community and contributing to the improvement of national health. All of this was possible as a result of an ambitious and optimistic management of objectives, based on collective and individual effort, as well as relying on the support of national and international bodies. This dynamizing and influential role played by the Hospital de Tacuarembó is based, on the one hand on a great improvement of its logistical base - that is, the hospital itself - in terms of its premises, equipment and upscaling of medical services, and on the other hand on the major support and stimulus to Primary Healthcare Services, not only in the city of Tacuarembó, but also throughout the entire province. Likewise, the HRT has played a significant role in the control of two parasite zoonoses that are extremely important for Uruguay: Chagas disease and cystic echinococcosis. This dynamizing actions have consisted in regarding the hospital as a "health organization" within the context of a certain territory, along with factors defined by the national health system. HRT may be considered as an innovative organization led by "social entrepreneurs" within the framework of social entrepreneurship, stemming from a departmental or province hospital.
Resumo: Descreve-se o desenvolvimento do Hospital Regional de Tacuarembó (HRT), localizado em uma cidade de médio porte do norte do Uruguai, o que o tornou uma referência dinâmica de saúde regional, com atendimento médico moderno e eficaz, além de atendimento à comunidade e a saúde nacional. Tudo isto alcançado através de uma gestão ambiciosa e otimista dos objectivos, baseada no esforço coletivo e individual, bem como no apoio institucional nacional e de organismos internacionais. Este papel dinâmico e influente a nível regional, e mesmo nacional, está baseado, por um lado, numa grande melhoria da sua base logística, ou seja, do próprio hospital, ao nível das instalações, equipamentos e ampliação das capacidades de assistência médica; mas também num grande apoio e dinamização da Atenção Primária à Saúde (APS) não só na cidade de Tacuarembó mas também a nível departamental. Além disso, o HRT tem desempenhado um papel importante no controle de duas zoonoses parasitárias de importância nacional: a doença de Chagas e a equinococose cística. Essa dinâmica de ação consistiu em considerar o hospital como uma "organização de saúde", considerando o contexto de um determinado território e os determinantes do sistema nacional de saúde. O HRT pode ser considerado uma organização inovadora liderada por "empreendedores sociais" dentro de um quadro de empreendedorismo social a partir de um hospital departamental ou provincial.
Subject(s)
Public Health , Hospitals , UruguayABSTRACT
Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community’s participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.
Subject(s)
Humans , Animals , Dogs , Dog Diseases/prevention & control , Echinococcosis/prevention & control , Dog Diseases/parasitology , Echinococcosis/epidemiology , Echinococcosis/veterinary , National Health Programs , Uruguay/epidemiologyABSTRACT
Presentamos el caso de una mujer de 32 años, con dos años de evolución de lesiones enpiel tipo placas, induradas, nodulares, dolorosas, inicialmente en miembros inferiores conposterior compromiso generalizado, con evidencia de lesiones cutáneas sugestivas dedermatomiositis y biopsia de piel que reporta calcinosis; inicialmente sin evidencia clínicani paraclínica que sugiriera compromiso muscular inflamatorio asociado. La resonanciamagnética nuclear de músculos y la biopsia muscular confirmaron la presencia de estecompromiso, definiendo los diagnósticos de dermatomiositis hipomiopática y calcinosisuniversal, dos espectros de una patología con baja frecuencia de presentación en lapoblación adulta.
The case is presented of a 32 year-old woman with indurated, raised and painful plaques in the skin of 2 years onset. It began in the legs, but later with a generalized extension to other regions, with evidence of cutaneous lesions very suggestive of dermatomyositis. The skin biopsy reported as calcinosis; initially without clinical evidence of inflammatory muscle compromise. A Nuclear Magnetic Resonance study and muscle biopsy showed this compromise, leading to the diagnosis of hypomyopathic dermatomyositis and universal calcinosis, two pathologies with rare presentation in an adult patient.
Subject(s)
Humans , Calcinosis , DermatomyositisABSTRACT
Introducción: La identificación radiológica de sacroiliítis es de vital importancia para el diagnóstico de las SpA, el uso de la resonancia magnética nuclear (RNM) ha ayudado en la detección temprana de este hallazgo, mejorando el tratamiento y pronóstico de los pacientes, con el inconveniente de ser un estudio costoso y de limitado acceso, lo que restringe su uso en la práctica clínica, situación que facilita la solicitud de estudios más económicos y de fácil acceso, como la radiografía de pelvis y la gammagrafía ósea (GO).Objetivos: Establecer la utilidad de la GO para el diagnóstico de sacroiliítis, en pacientes con SpA.Materiales y métodos: Se determinó sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la GO para el diagnóstico de sacroiliítis, usando como patrón de oro diagnóstico la RNM, en una cohorte colombiana de pacientes con diagnóstico de SpA.Resultados: Se analizaron 55 pacientes, 43.6% mujeres y 53.3% hombres, promedio de duración de la enfermedad 9.1±8.4 años, edad promedio de 31±10.5 años al inicio de los síntomas. Predominaron los pacientes con espondiloartritis no diferenciada (uSpA) (60.5%), y compromiso mixto (axial y periférico) (58,2%). El comportamiento de la GO fue sensibilidad 15% (IC 95% 0.04-0,25), especificidad 81% (IC 95% 0.72-0,9), valor predictivo positivo 32% (IC 95% 0.11-0.52), valor predictivo negativo 62% (IC 95% 0.52-0.72). Conclusiones: Se evidencia una sensibilidad variable de la GO con baja especificidad, valor predictivo positivo y valor predictivo negativo, para la detección de sacroiliítis, lo que permite establecer que no es útil como ayuda diagnóstica en espondiloartritis (SpA).
Introduction: Radiological identification of sacroiliitis is essential in the diagnosis of Sacroiliitis spondyloarthritis. Nuclear Magnetic Resonance has helped to optimize its early detection, Scintigraphy leading to improved treatment and a better prognosis for patients. The problem with NMR Spondyloarthritis is that it is expensive and there is limited access to it. For this reason cheaper studies such Magnetic resonance imaging pelvis x-rays and scintigraphy used more often than nuclear magnetic resonance in clinical practice. Objective: To determine the usefulness of scintigraphy in diagnosing sacroiliitis. Methods: The sensitivity, specificity, positive predictive value, negative predictive value of Bone Scintigraphy were analyzed for the diagnosis of sacroiliitis in a Colombian patient cohort with Spondyloarthritis using nuclear magnetic resonance as the gold standard. Results: A total of 55 patients were analyzed, 43.6% females and 53.3% males, with a mean disease duration of 9.1± years. The mean age of onset of symptoms was 31± years. Undifferentiated spondyloarthritis was the most frequent pathology (60.5%), and mixed pattern was the most common (58.2%). The scintigraphy performance compared to NMR was, sensitivity: 15% (95% CI; 0.04- 0.25), specificity: 81% (95% CI; 0.72- 0.9), positive predictive value: 32% (95% CI; 0.11-0.52), and negative predictive value: 62% (95% CI; 0.52-0.72). Conclusions: Scintigraphy has variable sensitivity but a low specificity, positive predictive value, and negative predictive value, for sacroiliitis detection, thus it can be said that it is not useful in the diagnosis of spondyloarthritis.