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1.
J Gastrointest Surg ; 2024 Jun 12.
Article in English | MEDLINE | ID: mdl-38876290

ABSTRACT

BACKGROUND: Narrowing, trauma, tumors, and systemic diseases can cause esophageal dysfunction. Severe cases resist traditional surgery, leading to long-term gastrostomy or jejunostomy tubes, affecting patients negatively. No established surgery ensures both airway and oral function with proper speech. This article introduces the oral-vestibule-enteral anastomosis (OVEA) technique, targeting patients with compromised epiglottic closure competence and loss of cervical esophagus, where conventional methods fall short. METHODS: Technique description study evaluated in 13 patients in a single tertiary referral center in Mexico City treated with OVEA from January 1990 to July 2023. RESULTS: Of the 13 patients (69% male; mean age, 37.14 ± 12.907 years), preoperative conditions included a mean body mass index of 17.78 ± 2.66 kg/m2, 46% with previous abdominal surgeries, and 31% with a smoking history. After OVEA, complications affected 46%, primarily pneumonia (23%), abscess formations (15%), intestinal necrosis (8%), and airway fistula (8%). Reoperation was needed in 38%, addressing functionality loss, necrosis, stenosis, and jawbone remodeling. No fatalities occurred within the first 6 months after surgery; 84% had successful gastrostomy tube removal, and 8% retained a tracheostomy tube. Currently 13 patients (92%) use the OVEA as their main enteral route of feeding. CONCLUSION: The OVEA technique seems promising for cases involving esophageal loss or impaired epiglottic function, enhancing patients' quality of life by enabling oral feeding and restoring regular eating habits. Further research should focus on long-term results and identifying optimal candidates for this innovative surgical method.

2.
Med. paliat ; 28(2): 111-119, abr.-jun. 2021. tab, graf, mapas
Article in Spanish | IBECS | ID: ibc-225426

ABSTRACT

Antecedentes: Los cuidados paliativos (CP) alivian el sufrimiento severo relacionado con la enfermedad grave y mejoran la calidad de vida. Son un elemento esencial de la cobertura sanitaria universal y su provisión es obligatoria en México. Sin embargo, existen importante retraso para la atención paliativa (AP) en el sector sanitario mexicano del que forma parte el Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE). Objetivo: Caracterizar la capacidad instalada para brindar CP en el ISSSTE y comparar la atención brindada con la necesidad calculada para 2019. Material y método: Estudio observacional, transversal, comparativo de prevalencias y mortalidad anual (2015-2019) de población institucional susceptible de beneficiarse de CP de acuerdo con The Lancet Commission report y los resultados de la caracterización de la capacidad instalada para atención paliativa en el ISSSTE. Resultados: Para 2019, las personas pudieron beneficiarse de AP por mortalidad: 7483 (44,65 %); por prevalencia global de enfermedades asociadas a sufrimiento severo relacionado con la enfermedad: 63.095 (16,9 %). Se otorgó CP en 6848 personas (58 % oncológicos; 51 % > 60 años), el 10,8 % del total calculado por prevalencia. Existe AP en 24 unidades médicas (14/3.er nivel [n = 15; 93,3 %], 7/2º nivel [n = 127; 7,87 %]), inexistente en 1.er nivel de atención; 11 (42 %) equipo ampliados; no se cuenta con equipos especializados de CP pediátricos; ninguna otorga atención de tiempo completo. Disponibilidad de opioides: buprenorfina transdérmica (77 %), tramadol inyectable (73 %), buprenorfina sublingual (69 %); morfina, buprenorfina y fentanilo (31 %); 16 centros realizan actividades académicas, 5 investigación. (AU)


Background: Palliative care (PC) alleviates severe suffering related to serious illness and improves quality of life. It is an essential element of universal health coverage and its provision is mandatory in Mexico. However, there are huge gaps between need and provision in the Mexican health sector, of which the Institute of Social Security and Services for State Workers (ISSSTE) is part. Objective: To characterize the installed capacity to provide PC in the ISSSTE, and to compare the care provided with the need as calculated for 2019. Material and method: An observational, cross-sectional, comparative study of prevalence and annual mortality (2015-2019) in the institutionalized population likely to benefit from PC according to The Lancet Commission report, and the results of the characterization of the installed capacity for PC in the ISSSTE. Results: In 2019 people can benefit from PC in the ISSSTE for mortality data was n = 7,483 (44.65 %); the global prevalence of diseases associated with serious health-related suffering was n = 63,095 (16.9 %); PC care was provided to 6,848 people (58 % oncological; 51 % > 60 years), 10.8 % of the total need calculated according to prevalence. There are PC services in 24 medical units (14/3rd level [n = 15; 93.3 %], 7/2nd level [n = 126; 3.06 %]), non-existent in 1st level of care; 11 (42 %) expanded teams; no pediatric PC teams. Full-time care was not offered; the reported opioid availability was TD/buprenorphine (77 %), tramadol injection (73 %), SL/ buprenorphine (69 %); morphine, buprenorphine, fentanyl, (31 %); 16 centers had academic activities regarding PC, and 5 had research. (AU)


Subject(s)
Humans , Palliative Care , Public Health , 50230 , Cross-Sectional Studies , Mexico , Health Systems
3.
Gac Med Mex ; 157(4): 436-442, 2021.
Article in English | MEDLINE | ID: mdl-35133349

ABSTRACT

The pandemic of SARS-CoV-2 infection, which causes COVID-19, has deeply affected health systems and has had a significant impact on families, communities and nations. A comprehensive response strategy requires, in addition to epidemiological, scientific and technical considerations, for human suffering associated with disease, vulnerability and death not to be forgotten. Palliative care for people with suspicion or diagnosis of COVID-19 with serious evolution, and their families should also be a key part of organized actions that help alleviate suffering and improve quality of life by controlling symptoms, addressing psychological, emotional, social and spiritual needs, support for advanced care planning and its goals, end-of-life care, as well as support in complex decision-making and ethical problems, among others. Recommendations are provided for offering palliative care in COVID-19 pandemic context.


La pandemia de infección por SARS-CoV-2, la cual es causada por COVID-19, ha afectado profundamente a los sistemas de salud y ha ocasionado un enorme impacto en las familias, las comunidades y las naciones. La estrategia de respuesta integral requiere que además de las consideraciones epidemiológicas, científicas y técnicas, no se olvide el sufrimiento humano asociado a la enfermedad, la vulnerabilidad y la muerte. La atención paliativa a personas con sospecha o diagnóstico de COVID-19 con evolución grave y sus familias debe ser también parte clave de la acción organizada que ayude al alivio del sufrimiento y mejore la calidad de vida mediante el control de los síntomas, el abordaje de las necesidades psicológicas, sociales y espirituales, el apoyo para la planificación de la atención avanzada y la articulación de los objetivos de la misma, el cuidado de la persona en la fase final de la vida, así como el soporte ante la toma de decisiones complejas y problemas éticos, entre otros. Se ofrecen recomendaciones para brindar los cuidados paliativos en el contexto de la pandemia de COVID-19.


Subject(s)
COVID-19 , Humans , Palliative Care , Pandemics , Quality of Life , SARS-CoV-2
4.
Clin Optom (Auckl) ; 8: 53-56, 2016.
Article in English | MEDLINE | ID: mdl-30214349

ABSTRACT

PURPOSE: This study sought to determine the prevalence of myopia in schoolchildren of a rural population in Mexico. METHODS: A cross-sectional study was conducted in 317 children between 6 and 12 years old. A complete refractive examination was performed, including static retinoscopy without cycloplegic agents. All procedures were conducted according to the Declaration of Helsinki. RESULTS: In total, 9.7% (95% CI: 13.07-6.52) of the examined children were myopic (spherical equivalent ≤ -0.50 D), 4.4% (95% CI: 6.66-2.14) presented astigmatism (cylinder ≤ -1.50 D), and 5.4% (95% CI: 7.89-2.91) presented hyperopia (spherical equivalent ≥ +0.50 D). CONCLUSION: Additional research is required to assess the prevalence of refractive errors in rural areas in Mexico, to analyze the associated risk factors, and to implement appropriate eye care plans for this population.

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