[Ethics in health technology assessment. Review]. / Ética y evaluación de tecnologías sanitarias. Revisión.

INTRODUCTION: Bioethics and the health technologies assessment emerged to help make decisions. The objective of the work was to know, with respect to the health technologies assessment, the scientific production on its ethical issues, the degree of incorporation of these in practice, the inclusion of the values in the deliberative processes and the most relevant approaches to ethical analysis. METHODOLOGY: A narrative review was made, based on a systematic search of literature in both natural and hierarchical language, using the terms technology assessment biomedical, ethics and deliberation (and its related terms). All types of papers published between May 2007 and April 2017 in Spanish, French, English or Italian that included both ethical aspects and health technology assessment were included. The PUBMED, OVID-Medline, Scopus databases and secondary searches were explored from the identified works. The information was extracted by a single researcher and managed with Mendeley and EPIINFO 7.2. RESULTS: A total of 141 papers were identified, including 85 after revision by title and summary, with the following characteristics: 29 reviews (5 systematic), 16 frameworks, 18 methodological works and 29 with description of experiences. Multiple frameworks, approaches and methods in ethical analysis were identified. CONCLUSION: The health technologies assessment has an approach excessively mechanistic, and can be improved by incorporating the values of the stakeholder, through deliberative processes. The methods of ethical analysis that seem most suitable are the axiological ones and those developed specifically for the health technologies assessment.

Digital tomosynthesis in breast cancer: A systematic review.

OBJECTIVE: To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer. MATERIAL AND METHODS: We systematically searched MedLine, EMBASE, and Web of Science for the terms breast cancer, screening, tomosynthesis, mammography, sensitivity, and specificity in publications in the period comprising June 2010 through February 2013. We included studies on diagnostic tests and systematic reviews. Two reviewers selected and evaluated the articles. We used QUADAS 2 to evaluate the risk of bias and the NICE criteria to determine the level of evidence. We compiled a narrative synthesis. RESULTS: Of the 151 original studies identified, we selected 11 that included a total of 2475 women. The overall quality was low, with a risk of bias and follow-up and limitations regarding the applicability of the results. The level of evidence was not greater than level II. The sensitivity of tomosynthesis ranged from 69% to 100% and the specificity ranged from 54% to 100%. The negative likelihood ratio was good, and this makes tomosynthesis useful as a test to confirm a diagnosis. One-view tomosynthesis was no better than two-view digital mammography, and the evidence for the superiority of two-view tomosynthesis was inconclusive. CONCLUSIONS: The results for the diagnostic validity of tomosynthesis in the diagnosis of breast cancer were inconclusive and there were no results for its use in screening.

[Place of death in Andalusia: influence of age, gender and cause of death]. / El lugar de la muerte en Andalucía: influencia de la edad, sexo y causa de defunción.

AIM: To know the place of death and its relationship to age, gender and causes of death. MATERIAL AND METHODS: A cross-sectional analysis of national population data using 31,463 deaths derived from Official Statistics on Mortality in Andalusia for the year 2009 was carried out. The variables studied were place of death (hospital, home or care home), age, gender and cause of mortality. Odds ratio adjusted by gender, age and cause of mortality using a multinomial logistic regression model. Place of death was chosen as dependent variable and age, gender and cause of death as independent ones. RESULTS: The place of death was hospital (61%), home (31%) and care home (8%). The higher the age, the higher the percentage of deaths at home and especially in care homes. Deaths in care homes are related to age (OR: 1,054; 95%CI: 1,049-1,059) and central nervous system (OR: 2,221; 95%CI: 1,826-2,071) and endocrine diseases (OR: 1,391; 95%CI: 1,141-1,697). There is a lower likelihood of dying at home due to digestive diseases (OR: 0,272; 95%CI: 0.23-0.32), genitourinary diseases (OR: 0.54; 95%CI: 0.44-0.65) and respiratory diseases (OR: 0.73; 95%CI: 0.64-0.82). CONCLUSIONS: Most Andalusians die in the hospital and increasing age has been found to be associated with higher probability of dying at home or in care homes. There are differences between death causes regarding place of death.

El lugar de la muerte en Andalucía: influencia de la edad, sexo y causa de defunción / Place of death in Andalusia: influence of age, gender and cause of death

Objetivo. Conocer el lugar de la muerte y su relación con la edad, sexo y causas de defunción. Material y método. Estudio transversal de base poblacional a partir de 31.463 defunciones procedentes de las estadísticas oficiales de mortalidad de Andalucía en el año 2009. Las variables estudiadas han sido: lugar donde ocurrió la muerte (hospital, domicilio o residencia socio-sanitaria), edad, sexo y causa de mortalidad. Se han calculado las odds ratio ajustadas por edad, sexo y causa de defunción mediante un modelo de regresión logística multinomial. Como variable dependiente se ha usado el lugar de fallecimiento y como independiente la edad, sexo y causa. Resultados. El lugar de fallecimiento fue: hospital (61%), domicilio (31%) y residencia socio-sanitaria (8%). A mayor edad aumenta el porcentaje de fallecidos en el domicilio y especialmente en las residencias respecto al hospital. Resultados. Las muertes en residencia se asocian con la edad (OR: 1,054; intervalo de confianza [IC] del 95%, 1,049-1,059) y las enfermedades del sistema nervioso central (OR: 2,221; IC del 95%, 1,826-2,701) y endocrinas (OR: 1,391; IC del 95%, 1,141-1,697). Resultados. Hay una menor probabilidad de morir en domicilio por las enfermedades digestivas (OR: 0,272; IC del 95%, 0,23-0,32), genitourinarias(OR: 0,54; IC del 95%, 0,44-0,65) y respiratorias (OR: 0,73; IC del 95%, 0,64-0,82). Conclusiones. La mayoría de los andaluces mueren en el hospital y a medida que aumenta la edad se incrementa la posibilidad de morir fuera del mismo. Hay diferencias significativas en la causa de defunción según el lugar de fallecimiento(AU)

Aim. To know the place of death and its relationship to age, gender and causes of death. Material and methods. A cross-sectional analysis of national population data using 31,463 deaths derived from Official Statistics on Mortality in Andalusia for the year 2009 was carried out. The variables studied were place of death (hospital, home or care home), age, gender and cause of mortality. Odds ratio adjusted by gender, age and cause of mortality using a multinomial logistic regression model. Place of death was chosen as dependent variable and age, gender and cause of death as independent ones. Results. The place of death was hospital (61%), home (31%) and care home (8%). The higher the age, the higher the percentage of deaths at home and especially in care homes. Results. Deaths in care homes are related to age (OR: 1,054; 95%CI: 1,049-1,059) and central nervous system (OR: 2,221; 95%CI: 1,826-2,071) and endocrine diseases (OR: 1,391; 95%CI: 1,141-1,697). Results. There is a lower likelihood of dying at home due to digestive diseases (OR: 0,272; 95%CI: 0.23-0.32), genitourinary diseases (OR: 0.54; 95%CI: 0.44-0.65) and respiratory diseases (OR: 0.73; 95%CI: 0.64-0.82). Conclusions. Most Andalusians die in the hospital and increasing age has been found to be associated with higher probability of dying at home or in care homes. There are differences between death causes regarding place of death(AU)

[Warning systems: a priority in epidemiological surveillance]. / Sistemas de alerta: una prioridad en vigilancia epidemiológica.

One of the functions of public health is to reduce the impact of emergency situations; hence the need to establish an early warning and response system. Community reactions to emerging and reemerging diseases, exposure to environmental risks, and potential terrorist acts are the factors that have that have mainly contributed to the instauration of warning systems based on mathematical models. Information is obtained from diverse sources (for example, laboratory data, sentinel physicians, or visits to particular websites). Once the data are gathered, and the situation provoking the alert is detected, control measures to reduce risks and minimize damage are taken at the earliest.

[Symptomatic diaphragmatic endometriosis. Laparoscopic treatment with laser CO2. Report of cases]. / Endometriosis diafragmática sintomática. Tratamiento laparoscópico con láser CO2. Informe de casos.

The endometriosis has been observed in 10% of the women in reproductive age and it is found in pelvis in most of the cases. However, occasionally it is located on nonpelvic organs and infrequently in diaphragmatic location. Two cases of diaphragmatic endometriosis with symptoms are presented and treated with CO2 laser successful. There are a few reports of laparoscopic treatment of diaphragmatic endometriosis. The patients with clinical diagnosis of endometriosis and nonpelvic symptoms have the possibility of the disease in nonpelvic organs. The adequate treatment will be in benefit of the patient.

[Osseous metaplasia of the endometrium as a cause of infertility. Hysteroscopic approach]. / Metaplasia ósea del endometrio como causa de infertilidad. Abordaje histeroscópico.

The osseous metaplasia of the endometrium is very rare cause of infertility. The hysteroscopic approach is a effective method to recover the fertility in most of the cases in a short period. The case of a infertile woman who was previous studied and has indications for laparoscopic and hysteroscopic approach. The infertility workup showed a intracavitary calcification on ultrasonography. During the surgery, the diagnosis of endometriosis and osseous metaplasia of the endometrium were done and treated with histologic confirmation. The patient conceived in her second spontaneous cycle. The hysteroscopy is the first approach in the treatment and should be doing with laparoscopy for the detection of other causes of infertility.

[Prognostic importance of controlled ovarian hyperstimulation previous to therapeutic laparoscopy of infertile patients]. / Importancia pronóstica de la hiperestimulación ovárica controlada previa a laparoscopia terapéutica en pacientes infértiles.

The use of the laparoscopic approach in the initial evaluation of the infertile couple without obvious disease is controversial; for these reason some centers has been done the initial treatment with ovarian stimulation (OS). The present article analyze two groups, the first for patients with OS for 4 cycles and laparoscopic approach after that and the second group with initial laparoscopy and medical treatment if they need it. Both groups has a OS after the laparoscopic procedure. The analysis of the prognosis of the OS before the laparoscopy and the impact in the reproductive outcome is done. The results shows that the OS does not have deleterious effects of the pregnancy rates if it is used before the procedure. However, the pregnancy are present early in the second group P < 0.05. In conclusion, in infertile woman without obvious disease that indicate the laparoscopy, the initial use of OS before the laparoscopy does not have a deleterious impact on the pregnancy rates.

[Analytic study of amniocentesis in prenatal genetic diagnosis. Transversal study of cases]. / Estudio analítico de la amniocentesis en el diagnóstico genético prenatal. Estudio transversal de casos.

The experience obtained in 44 cases, in which amniocentesis was practiced for genetic diagnostic purpose in the private center in México City is presented. Indications, morbility and results are similar to those reported in the literature, is considered that this method should be offered to the couples who receive information about it and have maternal age 35 or older, antecedent of family chromosomal disease, alteration in maternal serum screening or family anguish. This is a safe method and easy to perform with a high sensibility and specificity, this is the first report in a private center in México that analyzes technique.

[Current state of uterine tamponade with Foley catheter in intractable bleeding]. / Estado actual del taponamiento uterino con sonda de Foley en sangrado incoercible.

In obstetrics, the uterine tamponade has been used for the control of acute uterine bleeding. However, the control of the acute hemorrhage from the nonpuerperal uterus is more difficult. Four cases are presented with uterine bleeding during dilation and evacuation without response to medical treatment. They were treated with the use of the Foley catheter for 12 to 24 hrs. There were not complications. The uterine tamponade with Foley catheter is a therapeutic option before the radical surgical treatment.

[Septate uterus with cervical duplication and vaginal partition: a rare malformation]. / Utero septado con duplicación cervical y tabique vaginal: una malformación rara.

It presents three cases of Mullerian anomalies with septate uterus and cervical duplication and longitudinal vaginal septum. There are a few previous cases reported. The cases are discussed and the literature is revised.

[Vaginal hysterectomy assisted by laparoscopy. Critical and comparative study if vaginal and abdominal hysterectomy at the A.B.C. Hospital of Mexico]. / Histerectomía vaginal asistida por laparoscopia. Estudio crítico y comparativo con histerectomía vaginal y abdominal en el Hospital A.B.C. de la Ciudad de México.

The laparoscopically assisted vaginal hysterectomy offers the possibility to convert abdominal to vaginal approach give to the patient the benefits of ti. The analysis of the first 20 cases in our institution is done and are compared with abdominal and vaginal approaches in some parameters including costs, indications and hospitalization days. The laparoscopically assisted vaginal hysterectomy offers to the patient the benefits of the vaginal approach with hospital stay similar and cost and operative time higher than those for either vaginal and abdominal hysterectomy. The exact role of the laparoscopically assisted vaginal hysterectomy on daily practice still is pending.

[Intestinal endometriosis as an acute surgical emergency]. / Endometriosis intestinal como enfermedad quirúrgica aguda.

Endometriosis is rarely found by the general surgeon and sometimes it may seem a surgical disease. Two cases with abdominal pain, requiring surgical treatment, are presented. The first case gave history of dysmenorrhea and dyspareunia, she was admitted with acute abdomen due to acute appendicitis, and laparoscopic appendectomy was performed without complications; she had slight endometriosis at left utero-sacrum ligament and histopathological report showed endometriosis at the appendix. The second patient presented with incomplete obstruction related to ileocecal damage that it was resected with an histopathological report of endometriosis at cecum, ileon and appendix. The patient presented with endometriosis, degree IV, and had medical treatment with gestrinohn, during six months; latter on, HTA+SOB, was done, she received hormonal therapy. Endometriosis may be a cause for acute abdomen in women, and it should be considered in the differential diagnosis.