RESUMEN
OBJECTIVE: To describe the country's progress in eliminating neonatal tetanus based on the information obtained from epidemiologic surveillance. MATERIAL AND METHODS: A retrospective descriptive study of the epidemiological surveillance of neonatal tetanus in Colombia in the period ranging from 1989 to 2005. Available information was consulted regarding confirmations of this event of interest for Public Health. RESULTS: During the study period, a total of 830 cases of neonatal tetanus were reported. In 1989, the rate of neonatal tetanus in Colombia was 0.22 per 1000 live births. In 2005, this value was reduced to 0.01 cases per 1000 live births; a reduction of nearly 94 %. CONCLUSIONS: Given the information provided by epidemiological surveillance, Colombia has achieved the goal of maintaining a rate<1 case per 1000 live births. Nevertheless, even one case anywhere in the country should be considered a failure of the healthcare system.
Asunto(s)
Vigilancia de la Población , Tetania/prevención & control , Colombia , Bases de Datos Factuales , Notificación de Enfermedades , Objetivos , Humanos , Incidencia , Morbilidad/tendencias , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Tetania/epidemiologíaRESUMEN
Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.
Objetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce la incidencia de hipocalcémia sintomática. Se evalúa su costo-efectividad en Colombia. Materiales y métodos Utilizamos la información de un meta-análisis que comparó la administración de vitamina D o metabolitos contra calcio no tratamiento en pacientes llevados a tiroidectomía total y diseñamos un análisis de costo-efectividad basados en un modelos de decisiones con costos locales. Resultados El valor del OR para la comparación entre calcitriol y calcio comparado con no tratamiento o calcio exclusivo fue de 0.32 (95 % IC, 0.13- 0.79) y 0.31 (95 % IC, 0.14-0.70), respectivamente. La estrategia más costo-efectiva fue la administración de vitamina D o metabolitos y calcio, con una relación de costo-efectividad incremental de US $0.05. Conclusiones El tratamiento profiláctico de la hipo calcemia con vitamina D o metabolitos y calcio o calcio exclusivo después de tiroidectomía total es una estrategia costo-efectiva.
Asunto(s)
Humanos , Calcitriol/uso terapéutico , Carbonato de Calcio/uso terapéutico , Gluconato de Calcio/uso terapéutico , Hipocalcemia/prevención & control , Cuidados Posoperatorios/economía , Complicaciones Posoperatorias/prevención & control , Tiroidectomía , Calcitriol/administración & dosificación , Calcitriol/economía , Carbonato de Calcio/administración & dosificación , Carbonato de Calcio/economía , Gluconato de Calcio/administración & dosificación , Gluconato de Calcio/economía , Calcio/sangre , Colombia , Análisis Costo-Beneficio , Árboles de Decisión , Costos de los Medicamentos , Urgencias Médicas/economía , Hipocalcemia/economía , Hipocalcemia/epidemiología , Hipocalcemia/etiología , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Probabilidad , Tetania/epidemiología , Tetania/etiología , Tetania/prevención & controlRESUMEN
OBJECTIVE: Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. METHODS: Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. RESULTS: The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. CONCLUSION: Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.
Asunto(s)
Calcitriol/uso terapéutico , Carbonato de Calcio/uso terapéutico , Gluconato de Calcio/uso terapéutico , Hipocalcemia/prevención & control , Cuidados Posoperatorios/economía , Complicaciones Posoperatorias/prevención & control , Tiroidectomía , Calcitriol/administración & dosificación , Calcitriol/economía , Calcio/sangre , Carbonato de Calcio/administración & dosificación , Carbonato de Calcio/economía , Gluconato de Calcio/administración & dosificación , Gluconato de Calcio/economía , Colombia , Análisis Costo-Beneficio , Árboles de Decisión , Costos de los Medicamentos , Urgencias Médicas/economía , Humanos , Hipocalcemia/economía , Hipocalcemia/epidemiología , Hipocalcemia/etiología , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Probabilidad , Tetania/epidemiología , Tetania/etiología , Tetania/prevención & controlRESUMEN
In the present work a comparative quantitative evaluation of the differential effects of neuromuscular blockers on twitches and tetani was performed, encompassing: atracurium, cisatracurium, mivacurium, pancuronium, rocuronium and vecuronium. The sciatic nerve-extensor digitorum longus muscle of the rat was used, in vitro. Twitches were evoked at 0.1 Hz and tetani at 50 Hz. The differential effects of the studied compounds on twitches and tetani were statistically compared using simultaneous confidence intervals for the ratios between mean IC(50) for the block of twitches and mean IC(50) for the block of tetani. The results of ratios of mean IC(50) together with their corresponding 95% simultaneous confidence intervals were: vecuronium: 2.5 (1.8-3.5); mivacurium: 3.8 (3.0-4.9); pancuronium: 3.9 (2.0-7.6); rocuronium: 6.1 (3.8-9.9); atracurium: 9.0 (6.4-12.6); cisatracurium: 13.1 (6.0-28.4). Using the criteria that neuromuscular blockers displaying disjunct confidence intervals for the ratios of mean IC(50) differ statistically with regard to differential effects on twitches and tetani, significant differences in ratios of IC(50) were detected in the following cases: vecuronium vs. rocuronium, vs. atracurium and vs. cisatracurium and mivacurium vs: cisatracurium and vs. atracurium. The results show that the magnitude of the differential effects of neuromuscular blockers on twitches and tetani, as evaluated in the present work in the form of ratios of mean IC(50), does not depend on the chemical structure (comparing steroidal and isoquinolinic compounds), but seems to depend on differential pre- and post-synaptic effects of the compounds. It is also suggested that the greater the ability of a compound to block twitches and tetani in a differential manner, the safer is the compound from the clinical anesthesiology viewpoint.
Asunto(s)
Músculo Esquelético/efectos de los fármacos , Bloqueantes Neuromusculares/uso terapéutico , Tetania/prevención & control , Animales , Intervalos de Confianza , Femenino , Técnicas In Vitro , Masculino , Contracción Muscular/efectos de los fármacos , Contracción Muscular/fisiología , Músculo Esquelético/fisiología , Bloqueantes Neuromusculares/farmacología , Unión Neuromuscular/efectos de los fármacos , Unión Neuromuscular/fisiología , Ratas , Ratas Wistar , Espasmo/fisiopatología , Espasmo/prevención & control , Tetania/fisiopatologíaRESUMEN
In the present work a comparative quantitative evaluation of the differential effects of neuromuscular blockers on twitches and tetani was performed, encompassing atracurium, cisatracurium, mivacurium, pancuronium, rocuronium and vecuronium. The sciatic nerve-extensor digitorum longus muscle of the rat was used, in vitro. Twitches were evoked at 0.1 Hz and tetani at 50 Hz. The differential effects of the studied compounds on twitches and tetani were statistically compared using simultaneous confidence intervals for the ratios between mean IC(50) for the block of twitches and mean IC(50) for the block of tetani. The results of ratios of mean IC(50) together with their corresponding 95% simultaneous confidence intervals were vecuronium 2.5 (1.8-3.5); mivacurium 3.8 (3.0-4.9); pancuronium 3.9 (2.0-7.6); rocuronium 6.1 (3.8-9.9); atracurium 9.0 (6.4-12.6); cisatracurium 13.1 (6.0-28.4). Using the criteria that neuromuscular blockers displaying disjunct confidence intervals for the ratios of mean IC(50) differ statistically with regard to differential effects on twitches and tetani, significant differences in ratios of IC(50) were detected in the following cases vecuronium vs. rocuronium, vs. atracurium and vs. cisatracurium and mivacurium vs cisatracurium and vs. atracurium. The results show that the magnitude of the differential effects of neuromuscular blockers on twitches and tetani, as evaluated in the present work in the form of ratios of mean IC(50), does not depend on the chemical structure (comparing steroidal and isoquinolinic compounds), but seems to depend on differential pre- and post-synaptic effects of the compounds. It is also suggested that the greater the ability of a compound to block twitches and tetani in a differential manner, the safer is the compound from the clinical anesthesiology viewpoint.