The burden of treatment in people living with type 2 diabetes: A qualitative study of patients and their primary care clinicians.

BACKGROUND: The burden of treatment can overwhelm people living with type 2 diabetes and lead to poor treatment fidelity and outcomes. Chronic care programs must consider and mitigate the burden of treatment while supporting patients in achieving their goals. OBJECTIVE: To explore what patients with type 2 diabetes and their health providers consider are the workload and the resources they must mobilize, i.e., their capacity, to shoulder it. METHODS: We conducted focus groups comprised of 30 patients and 32 clinicians from three community health centers in Chile implementing the Chronic Care Model to reduce cardiovascular risk in patients with type 2 diabetes. Transcripts were analyzed using thematic content analysis techniques illuminated by the Minimally Disruptive Medicine framework. FINDINGS: Gaining access to and working with their clinicians, implementing complex medication regimens, and changing lifestyles burdened patients. To deal with the distress of the diagnosis, difficulties achieving disease control, and fear of complications, patients drew capacity from their family (mostly men), social environment (mostly women), lay expertise, and spirituality. Clinicians found that administrative tasks, limited formulary, and protocol rigidity hindered their ability to modify care plans to reduce patient workload and support their capacity. CONCLUSIONS: Chronic primary care programs burden patients living with type 2 diabetes while hindering clinicians' ability to reduce treatment workloads or support patient capacity. A collaborative approach toward Minimally Disruptive Medicine may result in treatments that fit the lives and loves of patients and improve outcomes.

Caracterización de lesiones letales de la línea media facial en pacientes del Hospital Escuela Universitario, Honduras entre 2011-2014 / Characterization of lethal injuries of the facial midline in patients of the University School Hospital, Honduras between 2011-2014

Objetivo: Caracterizar lesiones letales de línea media facial, signos y síntomas frecuentes, género y procedencia de los pacientes, histopatología e inmunohistoquímica en base a registros médicos institucionales de HEU entre 2011 y 2014.La lesión letal de línea media es un síndrome que inicialmente engloba variadas entidades: Linfomas no Hogdkin de células NK y T, Linfomas no Hogdkin de células B, enfermedades autoinmunes como la Granulomatosis con Poliangeítis, muchas causas infecciosas e idiopáticas con destrucción acelerada y catastrófica de la región nasofaríngea, senos paranasales y septum nasal. Síndromes de difícil diagnóstico con enfoques terapéuticos muy distintos. Metodología. Se realizó un estudio descriptivo, transversal, con revisión de todos los registros de biopsias realizados en el departamento de Anatomía Patológica del HEU desde el año 2011 al 2014. Cumplen criterios de inclusión, 34 casos. Resultados: Mayor prevalencia de lesiones en hombres 59 %, dentro del rango de edad de 19 a 59 años, con predomino de la región central de Honduras. Signo más frecuente: masa obstructiva. Diagnóstico más consignado fue Linfoma No Hodgkin sin especificación. Conclusión: Frecuencia de lesiones letales de la línea media es mayor en varones, procedentes en su mayoría de región central, síntoma y signo más frecuentes son masa obstructiva con ulceración y la rinorrea purulenta; la utilización de marcadores de inmunohistoquímica es deficiente para definir los casos inespecíficos de Linfoma No Hodgkin Nasales.

Objective: To characterize lethal facial midline lesions, frequent signs and symptoms, gender and origin of the patients, histopathology and immunohistochemistry based on HEU institutional medical records between 2011 and 2014. Lethal midline injury is a syndrome that initially encompasses a variety of entities: non-Hogdkin lymphomas of NK and T cells, non-Hogdkin B-cell lymphomas, autoimmune diseases such as granulomatosis with polyangiitis, many infectious and idiopathic causes with accelerated and catastrophic destruction of the nasopharyngeal region, paranasal sinuses and nasal septum. Syndromes which are difficult to diagnose with very different therapeutic approaches.Methodology. A descriptive, crosssectional study was carried out with a review of all biopsy registries performed in the Department of Pathological Anatomy of HEU from 2011 to 2014. 34 cases meet the inclusion criteria. Results: There was a higher prevalence in men 59%, within the age range of 19 to 59 years, with predominance of the central region of Honduras. Most frequent sign: obstructive mass. Most diagnosed was Non-Hodgkin's lymphoma without specification. Conclusion: Frequency of lethal midline lesions is greater in males, mostly from the central region. The most frequent symptoms and signs are obstructive mass with ulceration and purulent rhinorrhea; the use of immunohistochemical markers is deficient to define nonspecific cases of Nasal Non-Hodgkin's Lymphoma.

Secuestro pulmonar diagnosticado in útero: presentación de un caso / Pulmonary kidnapping diagnosed in uters: case report

Presentamos el caso de un paciente diagnosticado de secuestro pulmonar que es una malformación congénita en la que una porción del territorio pulmonar embrionario se aisla del árbol traqueobronquial y recibe vascularización por una o varias arterias sistémicas. Tradicionalmente la angiografía ha permitido poner de manifiesto el vaso aberrante sistémico arterial. Sin embargo, en la actualidad la ecografía permite la demostración no invasiva de esta vascularización. La angiografía, que hasta ahora era imprescindible para el diagnóstico, ha pasado a un segundo plano, indicándose solamente en aquellos casos de que el Doppler no confirma la localización de la irrigación sistémica. En los últimos años se ha usado la tomografía axial computada para hacer el diagnóstico con mucho éxito.