Turismo médico en América: una revisión de sus dinámicas e influencias en los sistemas de salud / Medical tourism in America: A review of its dynamics and influences on health systems

Resumen Introducción: El turismo medico (TM) ha permitido que muchos países se destaquen a nivel mundial por la excelente prestación de asistencia médica a población extranjera. La regulación y evaluación de sus estándares permitirá la seguridad del paciente y el desarrollo económico de esta práctica. El presente artículo es el resultado de una revisión sistemática realizada con el objetivo de observar y determinar la dinámica e influencia de la práctica del TM en los diferentes países del continente americano. Métodos: Se realizó una revisión sistemática de información bibliográfica publicada a partir del año 2015 al 2020 en las bases de datos Pubmed de Medline, Scopus y ScIELO. Los criterios de exclusión incluyeron artículos en español e inglés que fueron realizados en países del continente americano y aquellos que describieran las características de la práctica de turismo médico. Resultados: Se identificaron 17 estudios. Los destinos comunes incluyen países de Latinoamérica, las complicaciones postatención fueron frecuentes en los turistas. Se destacó la ausencia de políticas que regulen la práctica de TM en los diferentes países y la importancia de los estándares de calidad, infraestructura sanitaria y los servicios turísticos de las zonas geográficas y loa atributos culturales. Conclusión: El área de las políticas, regulaciones internacionales y estándares de calidad que garanticen la seguridad del paciente, ha sido inexplorada, este estudio propone incentivar nuevas investigaciones en esta área y destaca la necesidad de la aplicación de estas en los países en estudio.

Abstract Introduction: Medical tourism has allowed many countries to stand out globally for the excellent provision of medical assistance to the foreign population. Its regulation and evaluation of standards will allow patient safety and the economic development of this practice. This article is the result of a systematic review carried out with the objective of observing and determining the dynamics and influence of the practice of medical tourism in the different countries of the American continent. Methods: A systematic review of the bibliographic information published from 2015 to 2020 in the Pubmed databases of Medline, Scopus and ScIELO was carried out. The exclusion criteria included articles in English, those that were carried out in countries of the American continent and those that described the characteristics of the practice of medical tourism. Results: Seventeen studies were identified. Common destinations include Latin American countries, post-care complications were frequent in tourists. The absence of policies that regulate the practice of medical tourism in different countries and the importance of quality standards, health infrastructure and tourist services in geographic areas were highlighted. Conclusion: The area of policies, international regulations and quality standards that guarantee patient safety has been unexplored, this study aims to encourage new research in this area and highlights the need for their application in the countries under study.

The Impact of the COVID-19 Pandemic on Mental Disorders. A Critical Review.

The COVID-19 pandemic has impacted the lives of the worldwide population. Citizens suffer the social, economic, physiological, and psychological effects of this pandemic. Primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages were used for a consensus critical review. The method was a narrative review of the available literature to summarize the existing literature addressing mental health concerns and stressors related to the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found the pandemic has had a direct impact on psychopathologies such as anxiety, increasing its ratios, and depression. Other syndromes such as burnout and post-traumatic stress disorder have increased with the pandemic, showing a larger incidence among medical personnel. Moreover, eating disorders and violence have also increased. Public authorities must prepare healthcare systems for increasing incidences of mental pathologies. Mental health apps are one of the tools that can be used to reach the general population.

Profibrotic Activation of Human Macrophages in Systemic Sclerosis.

OBJECTIVE: Genome-wide gene expression studies implicate macrophages as mediators of fibrosis in systemic sclerosis (SSc), but little is known about how these cells contribute to fibrotic activation in SSc. We undertook this study to characterize the activation profile of SSc monocyte-derived macrophages and assessed their interaction with SSc fibroblasts. METHODS: Plasma and peripheral blood mononuclear cells (PBMCs) were obtained from whole blood from SSc patients (n = 24) and age- and sex-matched healthy controls (n = 12). Monocytes were cultured with autologous or allogeneic plasma to differentiate cells into macrophages. For reciprocal activation studies, macrophages were cocultured with fibroblasts using Transwell plates. RESULTS: The gene expression signature associated with blood-derived human SSc macrophages was enriched in SSc skin in an independent cohort and correlated with skin fibrosis. SSc macrophages expressed surface markers associated with activation and released CCL2, interleukin-6, and transforming growth factor ß under basal conditions (n = 8) (P < 0.05). Differentiation of healthy donor monocytes in plasma from SSc patients conferred the immunophenotype of SSc macrophages (n = 13) (P < 0.05). Transwell experiments demonstrated that coculture of SSc macrophages with SSc fibroblasts induced fibroblast activation (n = 3) (P < 0.05). CONCLUSION: These data demonstrate that the activation profile of SSc macrophages is profibrotic. SSc macrophages are activated under basal conditions and release mediators and express surface markers associated with both alternative and inflammatory macrophage activation. These findings also suggest that activation of SSc macrophages arises from soluble factors in local microenvironments. These studies implicate macrophages as likely drivers of fibrosis in SSc and suggest that therapeutic targeting of these cells may be beneficial in ameliorating disease in SSc patients.

Epigenetic Mechanisms and Posttranslational Modifications in Systemic Lupus Erythematosus.

The complex physiology of eukaryotic cells is regulated through numerous mechanisms, including epigenetic changes and posttranslational modifications. The wide-ranging diversity of these mechanisms constitutes a way of dynamic regulation of the functionality of proteins, their activity, and their subcellular localization as well as modulation of the differential expression of genes in response to external and internal stimuli that allow an organism to respond or adapt to accordingly. However, alterations in these mechanisms have been evidenced in several autoimmune diseases, including systemic lupus erythematosus (SLE). The present review aims to provide an approach to the current knowledge of the implications of these mechanisms in SLE pathophysiology.

Complementary therapies for patients with systemic sclerosis.

Patients with systemic sclerosis often seek information regarding complementary and nutrition-based therapy. Some study results have shown that vitamins D and E, probiotics, turmeric, l-arginine, essential fatty acids, broccoli, biofeedback, and acupuncture may be beneficial in systemic sclerosis care. However, large randomized clinical trials have not been conducted. This review summarizes current data regarding various complementary therapies in systemic sclerosis and concludes with recommendations.

Integrated, multicohort analysis of systemic sclerosis identifies robust transcriptional signature of disease severity.

Systemic sclerosis (SSc) is a rare autoimmune disease with the highest case-fatality rate of all connective tissue diseases. Current efforts to determine patient response to a given treatment using the modified Rodnan skin score (mRSS) are complicated by interclinician variability, confounding, and the time required between sequential mRSS measurements to observe meaningful change. There is an unmet critical need for an objective metric of SSc disease severity. Here, we performed an integrated, multicohort analysis of SSc transcriptome data across 7 datasets from 6 centers composed of 515 samples. Using 158 skin samples from SSc patients and healthy controls recruited at 2 centers as a discovery cohort, we identified a 415-gene expression signature specific for SSc, and validated its ability to distinguish SSc patients from healthy controls in an additional 357 skin samples from 5 independent cohorts. Next, we defined the SSc skin severity score (4S). In every SSc cohort of skin biopsy samples analyzed in our study, 4S correlated significantly with mRSS, allowing objective quantification of SSc disease severity. Using transcriptome data from the largest longitudinal trial of SSc patients to date, we showed that 4S allowed us to objectively monitor individual SSc patients over time, as (a) the change in 4S of a patient is significantly correlated with change in the mRSS, and (b) the change in 4S at 12 months of treatment could predict the change in mRSS at 24 months. Our results suggest that 4S could be used to distinguish treatment responders from nonresponders prior to mRSS change. Our results demonstrate the potential clinical utility of a novel robust molecular signature and a computational approach to SSc disease severity quantification.