RESUMO
BACKGROUND: Fractional exhaled nitric oxide (FeNO) testing is a simple, noninvasive approach to assessing airway inflammation with minimal discomfort that provides results within a few minutes. For policy makers, the economic impact of this technology is the main concern, especially in developing countries. We evaluated the budget impact of asthma management using FeNO monitoring in patients aged between 4 and 18 years in Colombia. METHODS: A budget impact analysis was performed to evaluate the potential cost of FeNO monitoring. The analysis was based on a 5-year time horizon and performed from the perspective of the Colombian National Health System. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which FeNO is reimbursed, from the cost of conventional treatment without FeNO (management based on clinical symptoms [with or without spirometry/peak flow] or asthma guidelines [or both] for asthma-related cases). Univariate 1-way sensitivity analyses were performed. RESULTS: In the base case analysis the 5-year costs associated with FeNO and non-FeNO were estimated to be 469 904 130 and 480 485 149, respectively, indicating savings for the Colombian National Health System of 10 581 019 if FeNO is adopted for the routine management of patients with persistent asthma. This result proved to be robust in the univariate 1-way sensitivity analysis. CONCLUSION: FeNO monitoring generated cost savings in emergency settings for infants with persistent asthma. This evidence can be used by decision makers in Colombia to improve clinical practice guidelines and should be replicated to validate the results in other middle-income countries.
Assuntos
Asma , Expiração , Adolescente , Asma/tratamento farmacológico , Asma/terapia , Testes Respiratórios/métodos , Criança , Pré-Escolar , Colômbia , Teste da Fração de Óxido Nítrico Exalado , Humanos , Lactente , Óxido NítricoRESUMO
RESUMEN El siguiente caso clínico trata de una paciente, gestante tras fecundación in vitro, afecta de endometriosis profunda. Dicha paciente debutó durante el embarazo con un síndrome del seno cavernoso con cefalea e hipoestesia facial, siendo diagnosticada tras una exploración neurológica detallada y las pruebas complementarias pertinentes de un meningioma. Por este motivo, tuvo que ser sometida a una cesárea previa al abordaje terapéutico del tumor, dado el empeoramiento clínico progresivo que se estaba produciendo. Dado que en la literatura científica la asociación entre la endometriosis y la aparición de meningiomas ya ha sido descrita, con este caso clínico intentaremos acercarnos a las posibles causas de dicha asociación, como podría ser el ambiente predominantemente estrogénico de las pacientes con endometriosis. De igual modo, abordaremos el manejo del meningioma tanto dentro como fuera del embarazo, sirviéndonos para ello de la bibliografía disponible.
ABSTRACT A pregnancy woman affected by deep endometriosis is presented in this clinical case. A cavernous sinus syndrome was diagnosed during her pregnancy. She started suffering from headache and facial hypoesthesia. After a detailed neurological examination and the relevant complementary tests the patient was diagnosed of a meningioma. Given the progressive clinical worsening that was taking place, she had to undergo a cesarean section prior to the therapeutic approach of the tumor. Through this clinical case we will try to approach the possible causes of the association between endometriosis and meningioma, such as the predominantly estrogenic environment of patients with endometriosis. Similarly, we will address the management of meningioma both inside and outside of pregnancy, using the related available literature.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Endometriose/diagnóstico , Endometriose/patologia , Meningioma/diagnóstico por imagem , Neoplasias Ovarianas , Neoplasias Meníngeas , Meningioma/tratamento farmacológicoRESUMO
Se estudiaron 171 embarazadas que tenian indicacion de amniocentesis para diagnosticar madurez pulmonar fetal. Anexo de la misma se clasifico la placenta en inmadura, intermedia y madura, considerando la caracteristica que mas superficie ocupaba de la plasenta. De los 123 embarazos de termino, 44 (35.8%) presentaron plancentas ecograficamente maduras y estas se asociaron en el 98%, 96%, 93% con la presencia de fosfolipidos en el liquido amniotico en toda la muestra, en menores de 37 semanas y en menores de 35 semanas respectivamente. con los recien nacidos cuyos partos se produjeron dentro de los 7 dias del examen, se calculo la eficacia diagnostica de la imagen ecografica de la placenta para predecir en forma antenatal la enfermedad de la membrana hialina (EMH), encontrandose que la placenta madura predecia en un 100% la ausencia de EMH. El procentaje de imagenes ecograficas de placentas maduras a diferentes edades gestacionales, solo es superado por la relacion L/E mayor o igual a 2