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RESUMEN Introducción: Las personas con disforia de género sienten incongruencia entre el sexo con el que nacen y aquel al que sienten pertenecer, por lo que necesitan adaptar su cuerpo a este último, y uno de los pilares en el logro de ese propósito es el empleo del tratamiento hormonal cruzado. Objetivo: Identificar los esquemas terapéuticos más empleados en la automedicación y en el manejo especializado, y sus complicaciones en pacientes con disforia de género. Métodos: Se revisaron 78 historias, de las cuales 76 correspondían a transexuales hombre-mujer, atendidos en el periodo 2012-2017 en la Consulta Nacional de Atención Integral a Personas Transgénero. Se recuperó información relacionada con los esquemas terapéuticos utilizados, tanto durante la automedicación como durante el manejo por el endocrinólogo, y las complicaciones. Para el análisis de los datos se obtuvieron distribuciones de frecuencia de las variables cualitativas, media y desviación estándar de las cuantitativas. Resultados: La frecuencia de pacientes que se autoadministraron hormonas antes de comenzar la atención especializada fue de 82,9 por ciento. El medicamento más utilizado en la automedicación fue la cipresta (acetato de ciproterona 2 mg/etinilestradiol 50 µg) en el 90,5 por ciento de los casos. De los tratamientos indicados por el endocrinólogo al inicio de la atención; al 50,0 por ciento se les administró cipresta más androcur (acetato de ciproterona 50 mg) de 1 a 2 tabletas de cada uno, mientras que al 39,5 por ciento estrógenos conjugados asociado a androcur, igualmente de 1 a 2 tabletas de cada uno de estos medicamentos. En cuanto a la frecuencia de complicaciones como consecuencia del tratamiento hormonal, el 40,7 por ciento de los casos tuvo en algún momento niveles elevados de prolactina, al 26,3 por ciento los niveles de triglicéridos se le elevaron luego de iniciada la terapia. Conclusiones: La mayoría de los pacientes acuden por primera vez automedicados. Los medicamentos más utilizados son la cipresta y el androcur. La complicación más frecuente como consecuencia del tratamiento es la hiperprolactinemia(AU)
ABSTRACT Introduction: Persons with gender dysphoria feel incongruity between the sex they are born with and the one they feel they belong to, therefore they need to adapt their body to the latter, and one of the pillars in achieving that purpose is the use of cross hormonal treatment. Objective: To identify the therapeutic schemes most used in self-medication and specialized management, and their complications in patients with gender dysphoria. Methods: Seventy eight medical records were reviewed. Seventy six of them corresponded to male-female transsexuals, assisted in the 2012-2017 period at the National Consultation of Comprehensive Care to Transgender Persons. The study team recovered information related to the therapeutic schemes used, both during self-medication and during the endocrinological management, as well as complications. Frequency distributions of the qualitative variables, mean and standard deviation of the quantitative variables were obtained for data analysis. Results: The frequency of patients who self-administered hormones before beginning specialized care was 82.9 percent. The most commonly medication used in self-medication was cypress (cyproterone acetate 2 mg / ethinylestradiol 50 µg) in 90.5 percent of cases. Out of the treatments indicated by the endocrinologist at the beginning of the care; 50.0 percent were given cypress plus androcur (50 mg cyproterone acetate) of 1 to 2 tablets each, while 39.5 percent conjugated estrogens associated with androcur, also 1 to 2 tablets of each of these medications. Regarding the frequency of complications as a result of hormonal treatment, 40.7 percent of the cases had elevated prolactin levels at some time, and triglyceride levels increased to 26.3 percent after the start of therapy. Conclusions: Most patients who come for the first time, are self-medicated. The most used medications are cipresta and androcur. The most frequent complication is hyperprolactinemia as a consequence of treatment(AU)
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Humans , Male , Female , Adult , Hyperprolactinemia/complications , Cyproterone Acetate/therapeutic use , Hormone Replacement Therapy/adverse effects , Gender Dysphoria/etiology , Self Medication/adverse effects , Data AnalysisABSTRACT
Objective To summarize experience in treating patients with native value endocarditis ( NVE) , and discuss the effect of timing of surgery on the infection control , cardiac function recovery and long-term mortality among patients . Methods Eighty NVE cases with antibiotic treatment were recruited between January 2006 and May 2013 .According to the timing of surgery, the subjects were divided into the early surgery group (38 cases) and the late surgery group (42 ca-ses) .The infection-related markers and cardiac function indexes before and after surgery , and 1-year, 3-year and 5-year mortality after surgery were analyzed .Results The infection control and recovery of cardiac function in the early surgery group were better than in the late surgery group (P<0.05).The difference in 3-year and 5-year mortalities between the two groups was significant .Conclusions For NVE patients with routine antibiotics treatment , the surgical effect and long-term survival rate are much better in the early surgery group than in the late surgery group .
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Se realizó una investigación enmarcada en los estudios de utilización de medicamentos del tipo indicación-prescripción, que incluyó a 50 pacientes con insuficiencia cardíaca, ingresados en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante el 2006, con vista a evaluar la individualización del tratamiento, el esquema terapéutico y las combinaciones medicamentosas. Se emplearon diuréticos, digitálicos e inhibidores de la enzima convertidora de angiotensina, entre los cuales predominaron la furosemida, la digoxina y el captopril, cuya indicación se consideró inadecuada, fundamentalmente por incumplimiento del estándar establecido
An investigation comprised in the studies of the type indication-prescription drugs use, that included 50 patients with heart failure, admitted at Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during the 2006 was carried out, aimed at evaluating the individualization of treatment, the therapeutic scheme and the drug combinations . Diuretics, digitalics and inhibitors of the angiotensin converting enzyme were used, among which there were furosemide, digoxin and captopril prevailed, and their indication was considered inadequate, mainly due to the unfulfillment of the established standard
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Humans , Male , Female , Drug Combinations , Drug Prescriptions , Heart Failure , Heart Failure/drug therapy , Secondary CareABSTRACT
OBJECTIVE To analyze the antimicrobial therapeutic schemes in appendectomy inpatients so as to(evaluate) the economic impact factors of each project.METHODS Totally 286 medical cases of appendectomy inpatients were chosen and analyzed from 2003 to 2005.The antimicrobial agent costs of each scheme were evaluated by(using) cost minimization analysis of pharmacoeconomic method.RESULTS There were 24 kinds of antimicrobial therapeutic schemes used by 286 cases.The commonest schemes were nitrodazoles + ?-lactams and nitrodazoles + ?-lactams + aminoglycosides(or clindamycin). The drug costs were 1671.46 and 1977.13 yuan(RMB)(individually) in combination of two or three kinds of antimicrobial agents.Choosing metronidazole instead of ornidazole could reduce drug fee significantly,which was also observed in choosing ceftazidime instead of other ?-lactams.CONCLUSIONS The antimicrobial drug utilization in our hospital is rational as a whole.Considering of economic factors,using metronidazole and ceftazidime(administering clindamycin if necessary) may be better than other schemes for prventing wound infection.
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OBJECTIVE:To evaluate the economic efficacy of 6 therapeutic schemes for hepatic lesions induced by chemotherapeutic drugs. METHODS: A total of 269 malignant tumor patients complicating hepatic lesion because of using of chemotherapeutic drugs were randomly divided into 6 groups (A, B, C, D, E and F) to be treated with Reduced Glutathione Sodium for Injection, Diammonium Glycyrrhizinate Injection, Compound Glycyrrhizin Injection, Polyene Phosphatidylcholine Injection, Compound Diisopropylamine Dichloroacetate Injection, Compound Ammonium Glycyrrhetate Injection, respectively. The curative effects were recorded and the cost-effectiveness analysis was conducted. RESULTS: In A, B, C, D, E and F groups, the effective rates were 91.67%, 75.00%, 86.05%, 84.78%, 87.50% and 85.42%, respectively, the costs were 798.28 yuan, 311.08 yuan, 859.88 yuan, 918.68 yuan, 1 092.28 yuan and 1 319.08 yuan, respectively, and the cost-effectiveness ratios were: 870.82, 414.77, 999.28, 1 083.60, 1 248.32 and 1 544.23, respectively. The incremental cost-effectiveness ratios for A, C, D, E, F groups as against group B were 2 922.62, 4 966.52, 6 212.68, 6 249.60 and 9 673.70, respectively. CONCLUSION: Group A was proved to be the safe, effective and economical therapeutic scheme for hepatic lesions induced by chemotherapeutic drugs.
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0.05),and their costs were 1 026.9,1 481.8,and 1 472.3 yuan respectively.CONCLUSION:The result showed that Group A was more reasonable and economical among the three schemes.
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Objective To explore the therapeutic principle and method for severe acute pancreatitis(SAP). Methods The treatment data from 102 cases with SAP in our department from 1990 to 2000 were analyzed retrospectively. Results Twenty two patients with SAP accompanied by biliary tract obstruction underwent surgical treatment with a healing rate of 91% and a death rate of 9%. In the 38 cases of SAP with biliary stone but without biliary tract obstruction, 20 patients underwent surgical treatment with a healing rate of 95% and a death rate of 5%, but 18 patients received non surgical treatment with the healing rate of 100%. Of the 42 cases of non biliary SAP, 23 patients underwent surgical treatment with a healing rate of 70% and a death rate of 30%, but 19 patients underwent non operative treatment with a healing rate of 84% and a death rate of 16%. Conclusion Patients with SAP accompanied by biliary tract obstruction should receive emergency operation, but those with SAP accompanied by biliary stone but without biliary tract obstruction should receive non operative treatment first. The surgical indications for non biliary SAP should be strictly controlled.
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OBJECTIVE:To evaluate the economic effectiveness of different pharmacotherapeutic schemes for peptic ulcer and chronic gastritis with infection of Helicobacteria pylori(Hp) METHODS:To perform cost-effectiveness analysis of three ther_apeutic schemes for Hp infection RESULTS:The cost-effectiveness ratios of three therapeutic schemes were 8 71,10 12 and 13 99 CONCLUSION:Scheme A(omeprazole+amoxicillin+clarithomycin) is the best one
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0.05), respectively. CONCLUSION: Scheme B is the preferable one in cost-effectiveness,however,Scheme C is the best one by comprehensive comparison.
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0.05);the total costs of L 1 group and L 2 group were424.76yuan and270.90yuan respectively,the cost of L 1 group was58%,higher than that of L 2 group.CONCLUSION:Considering from the perspective of pharmacoeconomics,L 2 group was a better one.
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OBJECTIVE:To evaluate the economic effectiveness of different pharmacotherapeutic schemes for the same disease Three therapeutic schemes(including A,B and C schemes)for peptic ulcer with Helicobacteria pylori were compared METHODS:The schemes were evaluated with pharmacoeconomic cost-effectiveness analysis RESULTS:The results showed that B was the best scheme from either cost-effectiveness analysis(C/E)or increasing costeffectiveness analysis(?C/?E) CONCLUSION:Pharmacoeconomics is very important in optimizing therapeutic scheme,guiding rational drug use and in_creasing economic effectiveness
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0.05),and the costs were 441.28,436.63,543.55 and 437.89 yuan respectively,showing no significant difference compared among Group A,B and D,but the cost in Group C was 20% higher than in other groups.CONCLUSION: Scheme C is recommended only when scheme A,B and D are invalid(such as the patients are allergic to Amoxicillin or Furazolidone or resistant to Metronidazole).