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1.
Gac. méd. Méx ; 156(6): 615-617, nov.-dic. 2020.
Article in Spanish | LILACS | ID: biblio-1249976

ABSTRACT

Resumen Extender una receta o indicar un tratamiento suele ser la última parte de la consulta médica. Este proceso crucial puede desvirtuarse debido a múltiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexión o tiempo. La información insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organización Mundial de la Salud, hace énfasis en hacer del proceso prescriptivo un ejercicio de reflexión.


Abstract Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise.


Subject(s)
Humans , Drug Prescriptions , Reflex , Practice Patterns, Physicians' , Conditioning, Psychological
2.
Gac. méd. Méx ; 156(6): 612-614, nov.-dic. 2020. tab
Article in Spanish | LILACS | ID: biblio-1249975

ABSTRACT

Resumen La automedicación y la autoprescripción son acciones de los pacientes; la primera como elemento del autocuidado que involucra medicamentos de venta libre y la segunda como una violación a la ley de salud, pues comprende medicamentos que solo pueden expenderse con receta. Todos los inconvenientes que se han atribuido a la automedicación en realidad lo son de la autoprescripción.


Abstract Self-medication and self-prescription are actions undertaken by patients; the former, as an element of self-care that involves over-the-counter drugs, and the latter, as a violation of the Statute of Health, since it includes drugs that can only be dispensed with a medical prescription. All the drawbacks that have been attributed to self-medication are actually associated with self-prescription.


Subject(s)
Humans , Self Care/methods , Self Medication , Self Administration , Prescription Drugs/administration & dosage , Attitude of Health Personnel
3.
Gac. méd. Méx ; 156(6): 610-611, nov.-dic. 2020.
Article in Spanish | LILACS | ID: biblio-1249974

ABSTRACT

Resumen La implementación en instituciones de salud de un cuadro básico permite adquirir y administrar una larga lista de medicamentos que presenta a los médicos las alternativas de tratamiento, así como la descripción académica colegiada de indicaciones, dosis, efectos secundarios, interacciones y análisis de costo-beneficio, con lo que se facilita la prescripción médica y la administración de insumos para la salud. El Comité de Ética y Transparencia en la Relación Médico-Industria emite diversas recomendaciones para la optimización de los beneficios generados por los cuadros básico de medicamentos.


Abstract The implementation of an essential medicines list in health institutions allows acquiring and administering a long list of drugs that offers treatment alternatives to physicians, as well as a collegiate academic description of indications, doses, side effects, interactions and cost-benefit analyses, thus facilitating medical prescription and administration of health products. The Committee of Ethics and Transparency in the Physician-Industry Relationship issues several recommendations for optimizing the benefits generated by essential medicines lists.


Subject(s)
Humans , Drug Prescriptions , Ethics Committees , Guidelines as Topic , Drugs, Essential/therapeutic use , Physicians/ethics , Cost-Benefit Analysis , Drug Industry/ethics
4.
Gac. méd. Méx ; 156(5): 467-468, sep.-oct. 2020.
Article in Spanish | LILACS | ID: biblio-1249947

ABSTRACT

Resumen Un capítulo novedoso es la atención y promoción por parte de médicos especialistas de aspectos relacionados con procedimientos estéticos, más que con la salud. La aspiración humana de la búsqueda de la belleza personal ha generado nuevos escenarios en la labor médica. El Comité de Ética y Transparencia en la Relación Médico Industria (CETREMI) de la Academia Nacional de México ha revisado esta circunstancia y emite recomendaciones tanto a los médicos como a los productores y potenciales consumidores de procedimientos estéticos.


Abstract A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.


Subject(s)
Humans , Surgery, Plastic/ethics , Beauty Culture/ethics , Guidelines as Topic , Commerce/ethics , Cosmetics , Dermatologists/ethics , Advisory Committees , Marketing/ethics , Mexico
5.
Gac. méd. Méx ; 155(5): 519-520, Sep.-Oct. 2019.
Article in English | LILACS | ID: biblio-1286554

ABSTRACT

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.


Subject(s)
Ethics Committees , Guidelines as Topic , Ethics, Medical , Conflict of Interest , Mexico
6.
Gac. méd. Méx ; 155(3): 319-321, may.-jun. 2019.
Article in English, Spanish | LILACS | ID: biblio-1286508

ABSTRACT

Resumen La investigación clínica es la herramienta de mayor importancia para la identificación de estrategias diagnósticas y terapéuticas que deriven en mayor eficacia y seguridad. A pesar de su trascendencia, la implementación exitosa de la investigación clínica presenta numerosas dificultades; entre las más relevantes se encuentra la poca disponibilidad de recursos para realizar ensayos clínicos independientes. Por lo general, la industria farmacéutica absorbe los costos asociados con la mayoría de los ensayos clínicos, sin embargo, esto puede generar una disociación entre los temas de interés y las prioridades en salud, al existir interés económico como principal motivación de estos protocolos. Además del papel relevante de la industria farmacéutica, es importante que las instancias gubernamentales favorezcan las condiciones, tanto económicas como regulatorias, para la implementación de investigación clínica independiente, que aborde temas de interés médico y terapéutico, aunque no genere beneficios económicos empresariales.


Abstract Clinical research is the most important tool for the identification of diagnostic and therapeutic strategies that derive in higher efficacy and safety. Despite its significance, successful implementation of clinical research faces numerous difficulties, with one the most relevant being limited availability of resources for the performance of independent clinical trials. Generally, the pharmaceutical industry absorbs the costs associated with most clinical trials; however, this can generate dissociation between subjects of interest and health priorities when economic interest is the main driver of these protocols. In addition to the relevant role played by the pharmaceutical industry, it is important that government agencies favor adequate conditions, both in economic and regulatory aspects, for the implementation of independent clinical research that addresses subjects of medical and therapeutic interest, even if it does not generate corporate economic benefits.


Subject(s)
Humans , Clinical Trials as Topic/organization & administration , Biomedical Research/organization & administration , Drug Industry/organization & administration , Financial Support , Clinical Trials as Topic/economics , Biomedical Research/economics , Drug Industry/economics
7.
Salud pública Méx ; 61(3): 352-358, may.-jun. 2019. tab
Article in English | LILACS | ID: biblio-1094474

ABSTRACT

Abstract: Lung cancer is a major global public health problem, yet the disease is highly stigmatized, which impairs the opportunities to get optimal treatment for these patients. Globally, as well as locally in Mexico, lung cancer is the main cause of cancer-related deaths. Despite this, it is the only one among the five deadliest cancers in Mexico which is not covered by Popular Health Insurance. Lung cancer treatment is a complex algorithm, which requires fully trained personnel to assess each patient in order to determine standard-of-care therapy based on several factors associated with the molecular profile of the tumor, as well as patient characteristics and their financial capabilities. Coupled to this, in the recent decade, several breakthrough therapies have been launched, shifting the outlook for certain patient subgroups. However, none of these novel therapies are currently available to patients who have public-based health insurance. In this paper, we review the inequities present in the Mexican health system and highlight the importance of addressing these opportunities.


Resumen: El cáncer de pulmón es un problema de salud pública a nivel global. Sin embargo, la enfermedad conlleva un gran nivel de estigma que disminuye las posibilidades de obtener un tratamiento óptimo para estos pacientes. El cáncer de pulmón es la causa principal de muertes relacionadas con cáncer, tanto en el mundo como localmente en México. A pesar de esto, en la lista de las cinco neoplasias con mayor mortalidad en México, el cáncer de pulmón es la única que no se encuentra cubierta por parte del Seguro Popular. El tratamiento del cáncer de pulmón es un algoritmo complejo, el cual requiere personal altamente calificado para la valoración de cada paciente y la determinación del estándar-de-cuidado, dependiendo de varios factores relacionados tanto con el perfil molecular del tumor como con las características del paciente y sus posibilidades económicas. Aunado a esto, en la década en curso ha surgido una gran cantidad de nuevas posibilidades terapéuticas que cambian el pronóstico de ciertos subgrupos de pacientes. Sin embargo, estas terapias no están disponibles para pacientes que se encuentran asegurados por parte del sistema público de salud en México. En este trabajo se revisaron las inequidades que se presentan en el sistema de salud en México y se recalcó la importancia de actuar sobre estas áreas de oportunidad.


Subject(s)
Humans , Healthcare Disparities , Health Services Accessibility/organization & administration , Lung Neoplasms/therapy , Mexico
8.
Salud pública Méx ; 61(3): 339-346, may.-jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1094472

ABSTRACT

Resumen: Objetivo: Analizar la cobertura en salud de cáncer pulmonar en México y ofrecer recomendaciones al respecto. Material y métodos: Mediante la conformación de un grupo multidisciplinario se analizó la carga de la enfermedad relativa al cáncer de pulmón y el acceso al tratamiento médico que ofrecen los diferentes subsistemas de salud en México. Resultados: Se documentan desigualdades importantes en la atención del cáncer de pulmón entre los distintos subsistemas de salud que sugieren acceso y cobertura en salud variable, tanto a los tratamientos tradicionales como a las innovaciones terapéuticas existentes, y diferencias en la capacidad de los prestadores de servicios de salud para garantizar el derecho a la protección de la salud sin distinciones. Conclusión: Se hacen recomendaciones sobre la necesidad de mejorar las acciones para el control del tabaco, el diagnóstico temprano y la inclusión de terapias innovadoras y la homologación entre los diferentes prestadores públicos de servicios de salud a través del financiamiento con la recaudación de impuestos al tabaco.


Abstract: Objective: To analyze the coverage of lung cancer in Mexico and offer recommendations in this regard. Materials and methods: By means of the conformation of a multidisciplinary group, we analyze the burden of the disease relative to the lung cancer and the access to the medical treatment offered by the different public health subsystems in Mexico. Results: Important inequalities in lung cancer care are documented among the different public health subsystems. Our data suggest differential access and coverage to both traditional treatments and existing therapeutic innovations and differences in the capacity of health service providers to guarantee the right to health protection without distinction. Conclusions: Recommendations are made on the need to improve actions for tobacco control, early diagnosis for lung cancer and inclusion of innovative therapies and homologation among different public health service providers through financing via tobacco taxes.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Health Services Accessibility , Health Services Needs and Demand , Lung Neoplasms/therapy , Public Health , Mexico
9.
Salud pública Méx ; 61(3): 329-338, may.-jun. 2019. graf
Article in English | LILACS | ID: biblio-1094471

ABSTRACT

Abstract: Objective: To review the state-of-the-art in relation to the current information on squamous cell lung cancer (SCLC). We describe the genetic anomalies reported, their effect, and finally the most promising therapeutic agents. Materials and methods: We reviewed published articles in peer-reviewed journals as well as current treatment guidelines from local and international resources. Results: SCLC represents a smaller proportion of the global burden of disease for lung cancer compared to its more frequent presentation, the adenocarcinoma. However, more than 400 000 cases are reported annually, a substantial population for whom therapeutic options are scarce and with limited efficacy. Several groups have been given the task of elucidating the mechanisms that lead to the development of SCLC, including molecular anomalies that can be used as targets for drug design. Conclusion: There are potential therapeutic targets for SCLC, which must be studied in clinical trials for validation.


Resumen: Objetivo: Revisar el estado del arte en relación con la información actual sobre el cáncer de pulmón de células escamosas (CPCE) y describir las anomalías genéticas reportadas, su efecto y los agentes terapéuticos más prometedores. Material y métodos: Se realizó una revisión de artículos publicados en revistas indizadas, así como las guías de tratamiento publicadas por instancias locales e internacionales. Resultados: El CPCE representa una proporción menor de la carga mundial de la enfermedad por cáncer pulmonar en comparación con su presentación más frecuente, el adenocarcinoma. Sin embargo, más de 400 000 casos son reportados anualmente, una población sustancial para quienes las opciones terapéuticas son escasas y con una eficacia limitada. Diversos grupos se han dado a la tarea de elucidar los mecanismos que conllevan al desarrollo del CPCE, incluyendo anomalías moleculares que puedan servir como blancos para el diseño de fármacos. Conclusiones: Existen blancos terapéuticos potenciales para el CPCE que deben ser estudiados en ensayos clínicos para ser validados.


Subject(s)
Humans , Carcinoma, Squamous Cell/genetics , Carcinoma, Squamous Cell/therapy , Precision Medicine , Lung Neoplasms/genetics , Lung Neoplasms/therapy , Genomics
10.
Salud pública Méx ; 61(3): 308-317, may.-jun. 2019. tab
Article in English | LILACS | ID: biblio-1094469

ABSTRACT

Abstract: Objective: Targeted next-generation sequencing (t-NGS) has revolutionized clinical diagnosis allowing multiplexed detection of genomic alterations. This study evaluated the profile of somatic mutations by t-NGS in Mexican patients with non-small cell lung cancer (NSCLC). Materials and methods: Genomic DNA was extracted from 90 lung adenocarcinomas and sequences were generated for a panel of 48 cancer genes. Epidermal Growth Factor Receptor (EGFR) mutations were detected in parallel by quantitative PCR. Results: The mutational profile of NSCLC revealed alterations in 27 genes, where TP53 (47.8%) and EGFR (36.7%) exhibited the highest mutation rates. EGFR Q787 mutations were present in 14 cases (15.6%), 10 cases had exon 19 deletions (11.1%), seven cases had L858R (7.8%). The mutational frequency for genes like EGFR, MET, HNF1A, HER2 and GUSB was different compared to caucasian population. Conclusion: t-NGS improved NSCLC treatments efficacy due to its sensitivity and specificity. A distinct pattern of somatic mutations was found in Mexican population.


Resumen: Objetivo: La secuenciación dirigida de nueva generación (SNG) permite la detección múltiple de mutaciones. Este estudio evalúa el perfil de mutaciones somáticas por SNG en pacientes mexicanos con cáncer de pulmón de células no pequeñas (CPCNP). Material y métodos: Se aisló ADN de 90 muestras de pacientes con CPCNP y se analizarón 48 genes relacionados con cáncer. Las mutaciones del receptor del factor de crecimiento epidérmico (EGFR) se detectaron por PCR cuantitativa. Resultados. Se detectaron alteraciones en 27 genes. Las mutaciones más frecuentes fueron TP53 (47.8%) y EGFR (36.7%). En el gen EGFR, 14 casos fueron mutaciones Q787 (15.6%), 10 presentaron microdeleciones en el exón 19 (11.1%), y siete en L858R (7.8%). La frecuencia de mutación en EGFR, MET, HNF1A, HER2 y GUSB fue diferente en comparación con población caucásica. Conclusión: NGS modifica el tratamiento del paciente con CPCNP por su sensibilidad y especificidad para detectar mutaciones. La población mexicana presenta un perfil mutacional particular.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/genetics , High-Throughput Nucleotide Sequencing , Lung Neoplasms/genetics , Mutation , Prospective Studies , Sequence Analysis, DNA , Mexico
11.
Salud pública Méx ; 61(3): 286-291, may.-jun. 2019. tab
Article in English | LILACS | ID: biblio-1094466

ABSTRACT

Abstract: Objective: To describe the epidemiological studies about the relationship between lung cancer (LC) and pulmonary tuberculosis (Tb) and its possible molecular mechanisms. Materials and methods: We reviewed research databases in search of publications that included keywords LC and Tb. Results: It has been proposed that chronic inflammation in the lungs due to Tb could cause clastogenic activity in the DNA of bronchial epithelium. Another possibility is lateral gene transfer; since Mycobacterium tuberculosis (MTb) is an intracellular organism, bacterial DNA could integrate to bronchial epithelial cells inducing neoplastic transformation. Conclusions: There are epidemiological reports, particularly from Asian countries, which confirm a relationship between LC and Tb. MTb could play an active role in cellular transformation and it is important to elucidate the mechanism involved.


Resumen: Objetivo: Describir los estudios que documentan la relación entre el cáncer de pulmón (CP) y la tuberculosis pulmonar (Tb) y sus posibles mecanismos moleculares. Material y métodos: Se revisaron bases de datos de publicaciones, usando como palabras clave CP y Tb. Resultados: Se ha propuesto que la inflamación crónica en el pulmón provocada por la Tb podría producir actividad clastogénica. Otra posibilidad es la transferencia lateral de genes; Mycobacterium tuberculosis (MTb) es un organismo intracelular facultativo cuyo DNA podría integrarse al material genético del epitelio bronquial induciendo transformación neoplásica. Conclusión: Existen evidencias epidemiológicas, particularmente en países asiáticos, que documentan la relación entre CP y Tb. MTb podría desempeñar un papel activo en la transformación neoplásica cuyo mecanismo debe de ser elucidado.


Subject(s)
Humans , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/epidemiology , Lung Neoplasms/complications , Lung Neoplasms/epidemiology
12.
Salud pública Méx ; 61(3): 265-275, may.-jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1094464

ABSTRACT

Abstract: Objective: To analyze the differences in the clinico-pathological and molecular characteristics of non-small cell lung cancer (NSCLC) as well as the clinical outcome of patients by sex and hormonal status. Materials and methods: We performed a retrospective study among 1 104 NSCLC patients. Clinic-pathologic data was recorded and survival outcomes were compared between male and female sex patients, and further by pre and postmenopausal status in females. Results: Women were significantly more likely to be non-smokers (p<0.001), had higher frequency of wood-smoke exposure (p<0.001), EGFR-sensitizing mutations (p<0.001), had better performance status (p=0.020) and had a better overall survival (OS) compared to men (p=0.021). Differences were found also by hormonal status, postmenopausal women had a longer OS compared to premenopausal women (31.1 vs. 19.4 months p=0.046). Conclusion: Our results support the differences in lung cancer presentation by sex and also by hormonal status.


Resumen: Objetivo: Analizar las diferencias en las características clínico-patológicas, moleculares y en la evolución del cáncer de pulmón de células no pequeñas (CPCNP) por sexo y estadio hormonal. Material y métodos: Estudio retrospectivo (N=1 104) en pacientes con CPCNP. Se recabaron datos clínico-patológicos y desenlaces de sobrevida y se compararon entre hombres y mujeres, y entre mujeres pre y postmenopáusicas. Resultados: Las mujeres de este estudio tuvieron significativamente mayor probabilidad de ser no fumadoras (p<0.001), tener exposición a humo de leña (p<0.001), mutaciones en EGFR (p<0.001), mejor estado funcional (p=0.020), y una mejor sobrevida global (SG) en comparación con los hombres (p=0.021). Estas diferencias también se encontraron en cuestión al estatus hormonal, con las mujeres postmenopáusicas presentando una mayor sobrevida en comparación con las premenopáusicas (31.1 vs. 19.4 meses; p=0.046). Conclusión: Los presentes resultados apoyan las diferencias en la presentación del CPCNP de acuerdo con el sexo y estatus hormonal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Sex Factors , Survival Rate , Retrospective Studies , Premenopause , Postmenopause , Mexico
13.
Salud pública Méx ; 61(3): 249-256, may.-jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1094462

ABSTRACT

Abstract: Objective: To analyze the mortality trend of lung cancer (LC) in Mexico, according to the municipality marginalization index (MMI) by age group and sex, during the period 1998-2016. Materials and methods: The information on mortality, population and MMI was obtained from the National Institute of Statistics and Geography (INEGI) and the National Council of Population (Conapo). The adjusted LC mortality rate trends were analyzed using the joinpoint regression analysis. A total of 126 132 deaths were included. Results: The adjusted LC mortality rate decreased from 7.83 to 4.97 100 000 inhabitants during the period from 1998-2016, but the decrease was found to be less in women and in areas with very high marginalization. Conclusions: Unequal reduction in LC mortality according to the degree of marginalization are related to early diagnosis, timely treatment and inequity in medical services. This inequity affects mainly the populations of women, highly marginalized groups and older populations.


Resumen: Objetivo: Analizar la tendencia de mortalidad por cáncer de pulmón (CP) en México, según el índice de marginación municipal (IMM) por grupo de edad y sexo, de 1998 a 2016. Material y métodos: La información sobre mortalidad, población e IMM se obtuvo del Instituto Nacional de Estadística y Geografía (INEGI) y del Consejo Nacional de Población (Conapo). Las tendencias de la tasa de mortalidad ajustada para CP se analizaron mediante el análisis de regresión de joinpoint. Se incluyeron 126 132 defunciones. Resultados: La tasa de mortalidad ajustada por CP disminuyó de 7.83 a 4.97 por 100 000 habitantes durante el periodo 1998-2016. Conclusiones: La reducción desigual en la mortalidad por CP, de acuerdo con el grado de marginación, está relacionada con en el diagnóstico temprano, el tratamiento oportuno y la inequidad en los servicios médicos. Esta inequidad afecta principalmente a las mujeres, a los grupos altamente marginados y a las poblaciones más envejecidas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lung Neoplasms/mortality , Time Factors , Mortality/trends , Social Marginalization , Mexico/epidemiology
16.
Gac. méd. Méx ; 155(2): 202-203, mar.-abr. 2019.
Article in Spanish | LILACS | ID: biblio-1286485

ABSTRACT

Resumen Los médicos requieren flexibilidad para sus prescripciones. Sin embargo, algunos límites están marcados tanto por el conocimiento vigente como por las restricciones de acceso, normas y reglamentos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) propone varias sugerencias para ayudar a los pacientes, que incluyen la selección de las mejores alternativas para cada caso, la protocolización de variaciones a los estándares de prescripción (dosis, indicaciones, etcétera) por escrito en el expediente y eludir modas, novedades no probadas, argumentos simplemente publicitarios o promocionales y conflictos de interés.


Abstract Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.


Subject(s)
Humans , Physicians/organization & administration , Practice Patterns, Physicians'/standards , Ethics, Medical , Physicians/ethics , Practice Patterns, Physicians'/ethics , Advisory Committees , Mexico
17.
Salud pública Méx ; 58(2): 274-278, Mar.-Apr. 2016.
Article in English | LILACS | ID: lil-792995

ABSTRACT

Abstract The management of lung cancer is challenging. However, nowadays the main goal is to achieve a significant overall survival accompanied by a good quality of life. Because smoking is associated with up to 71% of cancer deaths, the first policy that should be established is one that promotes strategies for healthy lifestyles by providing information about lung cancer, risk factors, protection factors, and precautionary data. Furthermore, an effective screening method that would allow early diagnosis should be established. Following diagnosis, the patient should be genotyped to identify predisposing mutations to give personalized medicine to the patient. The health system policies should include information that affects the health of the population and simultaneously allows for early diagnoses, resulting in a higher survival rate.


Resumen El manejo del cáncer de pulmón es un reto que tiene como objetivo una supervivencia global significativa que se vea rodeada de una buena calidad de vida. Si se considera que el tabaquismo está asociado hasta con 71% de las muertes por cáncer, la primera política que debe establecerse es la de proporcionar información sobre el cáncer de pulmón, factores de riesgo, factores de protección y datos de alarma mediante una estrategia de salud de línea de vida, además del establecimiento de un método de tamizaje efectivo que permita un diagnóstico temprano. Después del diagnóstico, debe realizarse una genotipificación para identificar mutaciones sensibles y para proporcionar un tratamiento personalizado al paciente. Las políticas del sistema de salud deben incluir información para que la población incida en su salud y también se puedan realizar diagnósticos tempranos que permitan una mayor supervivencia.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Preventive Health Services/organization & administration , Lung Neoplasms/prevention & control , National Health Programs/organization & administration , Primary Prevention/organization & administration , Smoking/adverse effects , Genetic Predisposition to Disease , Early Detection of Cancer , Secondary Prevention/organization & administration , Precision Medicine , Smoking Prevention , Genotype , Health Policy , Health Promotion , Lung Neoplasms/epidemiology , Mexico/epidemiology
18.
Arch. cardiol. Méx ; 77(3): 194-199, jul.-sept. 2007. tab, graf
Article in English | LILACS | ID: lil-566681

ABSTRACT

OBJECTIVES: We sought to identify predictors of in-hospital and long-term (> 1 year) mortality and major adverse cardiac events (MACE) in elderly patients referred for percutaneous coronary intervention (PCI). METHODS: Seventy-three patients (> or = 80 years) were included. Clinical and interventional characteristics were collected retrospectively. Primary end points were in-hospital and long-term mortality, and a composite of non-fatal myocardial infarction, target vessel revascularization, urgent coronary artery bypass graft surgery, and death (MACE). RESULTS: Eighty-three percent of the patients had acute coronary syndromes, 43% three-vessel disease, and 42% heart failure. In-hospital mortality and MACE were 16.4% and 19%, respectively. Long-term mortality and MACE were 11.3% and 16.4%, respectively. Univariate characteristics associated with in-hospital mortality and MACE were: Killip Class III-IV, heart failure, cardiogenic shock, TIMI 0-2 flow prior and after intervention, diabetes mellitus, contrast nephropathy, and presence of A-V block or atrial fibrillation (AF). Long term predictors for mortality were the presence of heart failure, cardiogenic shock, diabetes mellitus, TIMI flow 0-2 before and after intervention, and A-V block or AF. CONCLUSION: The identification of the factors previously mentioned may help to predict complications in elderly patients.


Subject(s)
Aged, 80 and over , Female , Humans , Male , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/mortality , Cardiovascular Diseases , Cardiovascular Diseases/mortality , Prognosis , Retrospective Studies , Risk Factors
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