Incidencia, tratamiento y seguimiento para paraganglioma del cuerpo carotideo enel Hospital Nacional Carlos Alberto Seguín Escobedo 2012-2020

El paraganglioma del cuerpo carotideo, es una tumoración benigna, bastante rara, cuya incidencia es mayor en zonas de altura de más de 2000msnm, tal como la ciudad de Arequipa. El tratamiento de elección es la exceresis subadventicial del mismo mediante cirugía, la cual es de extrema dificultad por la ubicación, su intimo contacto con la arteria carótida y la cantidad de elementos vasculonerviosos que se encuentran en su cercanía y el gran riesgo de sangrado, habitualmente la tumoración es resecada sin mayores complicaciones. El objetivo principal de esta investigación es determinar la incidencia, el tratamiento y seguimiento del paraganglioma del cuerpo carotideo en el Hospital Nacional Carlos Alberto Seguin Escobedo en la ciudad de Arequipa desde el año 2012 hasta al año 2020.Proyecto de Investigació

ADHERENCIA A AGENTES ANTIHIPERTENSIVOS EN PACIENTES HEMODIALIZADOS: FRECUENCIA Y FACTORES RELACIONADOS EN DOS HOSPITALES. AREQUIPA 2015

INSUFICIENCIA RENAL CRÓNICA PROBLEMA EN SALUD ETIOLOGÍA EPIDEMIOLOGÍA FISIOPATOLOGÍA ETAPAS DE LA INSUFICIENCIA RENAL CUADRO CLÍNICO CAUSAS DE MORTALIDAD COMPLICACIONES Y CONSECUENCIAS DE LA ENFERMEDAD RENAL CRÓNICA TRATAMIENTO AGENTES ANTIHIPERTENSIVOS OTRO FÁRMACOS REDUCCIÓN DE LA INGESTA PROTEICA Y OTRAS MEDIDAS DIETÉTICAS DIÁLISIS TRASPLANTE RENAL HIPERTENSIÓN ARTERIAL E INSUFICIENCIA RENAL CRÓNICA EFECTO DEL TRATAMIENTO DE LA HIPERTENSIÓN ARTERIAL SOBRE LA FUNCIÓN RENAL EFECTOS CRÓNICOS EFECTOS AGUDO

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research