Acceso a colecistectomía en un programa de tamizaje ecográfico de colelitiasis en centros de medicina familiar

Bay, Constanza; Ocares, Marcia; Toledo, Fernando; Barticevic, Nicolás; Mora, Isabel; Villouta, Francisca; Cruz, Francisco; Püschel, Klaus; Miquel, Juan Francisco

doi:10.4067/s0034-98872016000300006

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…Main complications of GSD are acute cholecystitis, acute pancreatitis and bile duct obstruction 3 , which are generally treated by surgical removal of the gallbladder (cholecystectomy). In Chile, these procedures account for more than 40,000 interventions each year 4 , with a net cost of more than US $25 million to the public healthcare system. Additionally, GSD is the main risk factor for gallbladder cancer (GBC), a disease that presents a high mortality rate in Chile, with 38.2 deaths per 100,000 inhabitants 5 .…”

Section: Introductionmentioning

confidence: 99%

Variants in ABCG8 and TRAF3 genes confer risk for gallstone disease in admixed Latinos with Mapuche Native American ancestry

Bustos

Pérez‐Palma

Buch

et al. 2019

Sci Rep

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Latin Americans and Chilean Amerindians have the highest prevalence of gallstone disease (GSD) and gallbladder cancer (GBC) in the world. A handful of loci have been associated with GSD in populations of predominantly European ancestry, however, they only explain a small portion of the genetic component of the disease. Here, we performed a genome-wide association study (GWAS) for GSD in 1,095 admixed Chilean Latinos with Mapuche Native American ancestry. Disease status was assessed by cholecystectomy or abdominal ultrasonography. Top-10 candidate variants surpassing the suggestive cutoff of P < 1 × 10−5 in the discovery cohort were genotyped in an independent replication sample composed of 1,643 individuals. Variants with positive replication were further examined in two European GSD populations and a Chilean GBC cohort. We consistently replicated the association of ABCG8 gene with GSD (rs11887534, P = 3.24 × 10−8, OR = 1.74) and identified TRAF3 (rs12882491, P = 1.11 × 10−7, OR = 1.40) as a novel candidate gene for the disease in admixed Chilean Latinos. ABCG8 and TRAF3 variants also conferred risk to GBC. Gene expression analyses indicated that TRAF3 was significantly decreased in gallbladder (P = 0.015) and duodenal mucosa (P = 0.001) of GSD individuals compared to healthy controls, where according to GTEx data in the small intestine, the presence of the risk allele contributes to the observed effect. We conclude that ABCG8 and TRAF3 genes are associated with GSD and GBC in admixed Latinos and that decreased TRAF3 levels could enhance gallbladder inflammation as is observed in GSD and GSD-associated GBC.

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Section: Introductionmentioning

confidence: 99%

Variants in ABCG8 and TRAF3 genes confer risk for gallstone disease in admixed Latinos with Mapuche Native American ancestry

Bustos

Pérez‐Palma

Buch

et al. 2019

Sci Rep

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“…Este modelo se diferenciaba del modelo de compra de servicios que requiere una derivación y nuevo control médico posterior para derivación en caso de que la paciente presente un examen alterado. El programa piloto demostró una reducción promedio de 4 meses en la latencia de cirugía en las pacientes que participaron del mismo y, un 50% de reducción en cirugías de urgencia comparado con mujeres que recibieron atención habitual (14) enfatizando la importancia de su implementación en APS en Chile.…”

Section: Diagnóstico Precoz: Enfermedad Vesicular Y Cáncer De Vesículaunclassified

Clinical Effectiveness of Primary Health Care in Chile: Innovations and Challenges

PÜSCHEL ILLANES

2024

BACM

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Chile presents a dissociation between the high level of human development indexes and public health indicators achieved versus the existent relatively low clinical effectiveness level, especially at the primary health care (PHC) system. PHC in Chile has developed a number of pilot innovations that could be replicated and escalated at a national level, to improve clinical effectiveness and the health care level of the population. The development of new models in clinical effectiveness in Chile, has been associated with significant reductions in inappropriate referrals, hospitalizations, emergency care visits and even general mortality. The Chilean PHC system has implemented pilot and innovative interventions in cancer prevention, early detection of gallbladder disease, peptic ulcer disease and gastric cancer, as well as innovative clinical management initiatives on COVID-19 infections and cardiovascular disease. Specific instruments and strategies have been tested and validated to implement the person-centered family systems approach. New initiatives on rapid tests and clinical ultrasound for cardiovascular and respiratory disease should be integrated soon in PHC in Chile given the existent evidence on their effectiveness and relative low cost. It is recommended to assess locally clinical new practices at the primary care level before escalating them to the entire network given that in many cases, available clinical information comes from clinical scenarios that are not necessarily equivalent to primary care. The primary care system in Chile has the challenge to implement strategies of proven effectiveness at local level that should be escalated to a national level.

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“…2 Main complications of GSD are acute cholecystitis, acute pancreatitis and bile duct obstruction, 3 and these are generally treated by surgical removal of the gallbladder (cholecystectomy). In Chile, these procedures accounts for more than 40,000 interventions each year, 4 with a net cost of more than US $25 million for the public healthcare system. GSD is also the main risk factor for gallbladder cancer (GBC), a disease that presents a high mortality rates in Chile (38.2 deaths per 100,000 inhabitants).…”

Section: Introductionmentioning

confidence: 99%

Common variants inABCG8andTRAF3genes confer risk for gallstone disease and gallbladder cancer in admixed Latinos with Mapuche Native American ancestry

Bustos

Pérez‐Palma

Buch

et al. 2018

Preprint

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Background: Latin Americans and Chilean Amerindians have the highest prevalence of cholesterol gallstone disease (GSD) and gallbladder cancer (GBC) in the world. A handful of loci have been associated with GSD in populations of predominantly European ancestry, however they only explain a small portion of the population-attributable risk of the disease. Methods:We performed a genome-wide association study (GWAS) for GSD in 1,095 admixed Latinos with Mapuche Native American Ancestry, followed by a replication analysis of 10 candidate single nucleotide polymorphisms (SNPs) with suggestive genomewide significance (P<1x10 -5 ) in 1,643 individuals. Disease status was assessed by cholecystectomy or abdominal ultrasonography. Logistic regression analyses were adjusted for age, sex, BMI, Type 2 Diabetes and Amerindian ancestry. Associated variants were further examined in two large GSD European populations and in a Chilean gallbladder cancer (GBC) cohort. We determined the expression levels of a novel GSD-candidate gene in normal and GSD-tissue samples. Results:We consistently replicated the ABCG8 gene (rs11887534; P=3.24x10 -8 , OR=1.74) associated with GSD in admixed Latinos and identified a novel candidate signal within the TRAF3 gene on chromosome 14 (rs12882491; P=1.11x10 -7 , OR=1.40). ABCG8 and TRAF3 variants also conferred risk to GBC. Gene expression analyses indicated that TRAF3 levels were significantly decreased in the gallbladder (P=0.015) and the duodenal mucosa (P=0.001) of affected GSD individuals compared to healthy controls. Conslusions:We confirmed ABCG8 and identified TRAF3 both associated with GSD and GBC in admixed Latinos. Decreased TRAF3 expression levels could enhance gallbladder inflammation as is observed in GSD and GSD-associated GBC.Gallstone disease (GSD) is a complex gastrointestinal disorder defined by the development of gallstones in the gallbladder, most of the time cholesterol compounds. 1 The presence of gallstones are common in the world population (~10-20% of presence in adults) and although their appearance can remain silent throughout life, more than 20% of the patients develop symptoms that include intense abdominal pain, jaundice, fever, nausea and vomiting, requiring medical attention and therefore establishing itself as a clinical condition . 2 Main complications of GSD are acute cholecystitis, acute pancreatitis and bile duct obstruction, 3 and these are generally treated by surgical removal of the gallbladder (cholecystectomy). In Chile, these procedures accounts for more than 40,000 interventions each year, 4 with a net cost of more than US $25 million for the public healthcare system. GSD is also the main risk factor for gallbladder cancer (GBC), a disease that presents a high mortality rates in Chile (38.2 deaths per 100,000 inhabitants). 5 In the vast majority of cases, GBC is an adenocarcinoma characterized by high lethality due to late diagnosis and the ineffectiveness of chemotherapy/radiotherapy. With the removal of the gallbladder and its stones, GBC risk is consid...

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Acceso a colecistectomía en un programa de tamizaje ecográfico de colelitiasis en centros de medicina familiar

Cited by 3 publications

References 27 publications

Variants in ABCG8 and TRAF3 genes confer risk for gallstone disease in admixed Latinos with Mapuche Native American ancestry

Variants in ABCG8 and TRAF3 genes confer risk for gallstone disease in admixed Latinos with Mapuche Native American ancestry

Clinical Effectiveness of Primary Health Care in Chile: Innovations and Challenges

Common variants inABCG8andTRAF3genes confer risk for gallstone disease and gallbladder cancer in admixed Latinos with Mapuche Native American ancestry

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