RESUMO
The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.
Assuntos
Cardiologia , Hipertensão , Humanos , Idoso , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea , Combinação de MedicamentosRESUMO
OBJECTIVES: Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. METHODS: Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. RESULTS: Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. CONCLUSIONS: A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a cost-benefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.
Assuntos
Plantão Médico/economia , Modalidades de Fisioterapia/economia , Plantão Médico/normas , Plantão Médico/estatística & dados numéricos , Chile , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Países em Desenvolvimento , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Modalidades de Fisioterapia/tendênciasRESUMO
It is well-known that mitochondrial DNA (mtDNA) can escape to intracellular or extracellular compartments under different stress conditions, yet understanding their escape mechanisms remains a challenge. Although Bax/Bak pores and VDAC oligomers are the strongest possibilities, other mechanisms may be involved. For example, mitochondria permeability transition, altered mitophagy, and mitochondrial dynamics are associated with intracellular mtDNA escape, while extracellular traps and extracellular vesicles can participate in extracellular mtDNA escape. The evidence suggests that mtDNA escape is a complex event with more than one mechanism involved. In addition, once the mtDNA is outside the mitochondria, the effects can be complex. Different danger signal sensors recognize the mtDNA as a damage-associated molecular pattern, triggering an innate immune inflammatory response that can be observed in multiple metabolic diseases characterized by chronic inflammation, including autoimmune diseases, diabetes, cancer, and cardiovascular disorders. For these reasons, we will review the most recent evidence regarding mtDNA escape mechanisms and their impact on different metabolic diseases.
Assuntos
DNA Mitocondrial/genética , Doenças Metabólicas/genética , Mitocôndrias/genética , Estresse Oxidativo/genética , Humanos , Inflamação/genética , Doenças Metabólicas/imunologia , Doenças Metabólicas/metabolismo , Doenças Metabólicas/patologia , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Transdução de Sinais/genéticaRESUMO
Enfrentamos actualmente una crisis que ha redefinido el comportamiento humano y está cambiando la historia de la humanidad. "La simple perspectiva de perder la vida por algo invisible pero omnipresente agobia la existencia de cada individuo social". La infección por los coronavirus en general ha tenido un comportamiento benigno y no había pasado de ser una "gripa" hasta que, en el 2002, 2012 y 2019 aparecen epidemia por estos coronavirus con la capacidad de producir infecciones mortales. De ellas, que respectivamente se han llamado SARS-CoV, MERS-CoV, SARS-CoV-2, siendo ésta última la responsable de la pandemia actual. La infección por SARS-CoV-2 en la actualidad ha afectado alrededor de 2,5 millones de personas y ocasionado alrededor de 160 mil muertes. Hasta hoy la única medida que se ha mostrado efectiva en el control de la infección es el aislamiento preventivo, buscando con éste evitar la aparición de enfermedad potencialmente mortal, cuyo tratamiento tiene costos enormes en equipos y personal hospitalario. Este aislamiento conduce a un freno de la economía y a una incapacidad del estado a mediano plazo para contener la crisis social creciente en varios componentes, ansiedad, depresión, desempleo, descuido en la atención de otras enfermedades potencialmente mortales, aplazamiento de cirugías electivas y hambre. Además de considerar el aislamiento como la piedra angular, es importante proponer alternativas de prevención y tratamiento de la enfermedad. A la fecha en términos de tratamiento son muchos los medicamentos probados, sin demostrarse todavía una eficacia que aliente el optimismo. Conocedores que somos de la importancia de brindar a los pacientes un medio de prevención y un método terapéutico efectivo de la infección, queremos proponer la ozonoterapia como parte del abanico de posibilidades que se le pueda ofrecer a los afectados por la infección, pero mejor aún, la enorme posibilidad que ésta podría brindar para evitar la misma y/o la progresión de la enfermedad hacia estadios graves. La ozonoterapia, mezcla de sangre venosa con ozono obtenido a partir de oxígeno medicinal, no es un procedimiento nuevo y poco probado, como si muchos de los medicamentos en curso de investigación para el manejo de la infección. Ésta existe desde 1935 y con ella se han manejado ya infecciones virales con éxito, incluso en la pandemia actual ya hay registros de su uso en Ibiza y en España con resultados que nos motivan a proponerla hoy en Colombia. Su aplicación puede abarcar la prevención y el tratamiento al poderse por este medio eliminar el virus circulante e inducir una respuesta antiinflamatoria que evite la agravación de la enfermedad y permita la recuperación más rápida de los pacientes. Queremos apoyar con este procedimiento a los pacientes afectados y a los contactos de ellos para abaratar los costos de manejo del paciente hospitalizado y de manera preventiva ayudar a enfrentar la crisis con miras a contener el desajuste económico que se avecina si no aparece un tratamiento diferente que sea efectivo.
Assuntos
Ozônio/uso terapêutico , COVID-19/epidemiologia , Terapias Complementares , ColômbiaRESUMO
Objetivo: describir la problemática de hombres y mujeres trabajadores que al percibir vulnerado su derecho a la salud en el trabajo por sufrir presuntos o declarados ATEL, buscaron apoyo e interpusieron uno o más recursos constitucionales para lograr su restablecimiento efectivo. Materiales y métodos: estudio mixto. Se aplicó encuesta a 189 trabajadores que sufrieron un presunto o reconocido evento de ATEL y que buscaron apoyo en los servicios de extensión solidaria de la Universidad de Antioquia o en organizaciones de derechos humanos en Medellín. La encuesta captó datos sociodemográficos, de seguridad social, laborales, del SGSST, de los antecedentes, ocurrencia y consecuencias de los ATEL y los recursos interpuestos. Para el abordaje cualitativo se realizó: i) una entrevista en profundidad con un médico laboral y abogado independiente y ii) cuatro grupos focales con trabajadores que sufrieron ATEL, sindicalistas, abogados y médicos representantes de ARL, académicos. Resultados: los trabajadores más vulnerables fueron los más afectados en su derecho. Los agentes que integran el SGRL hacen un abordaje fragmentado de la salud y el trabajo que facilita la vulneración del derecho. Los trabajadores que sufren ATEL deben enfrentar barreras económicas, administrativas y de acceso a salud para restituir su derecho. Conclusiones: el trabajo decente y digno es un horizonte hacia el cual se deben apuntar los esfuerzos para que los trabajadores más vulnerados históricamente conquisten y sostengan una vida plena, digna y saludable. Los recursos como la acción de tutela contribuyen a lograr el cumplimiento del derecho a la salud en el trabajo.
Objective: to describe the problems of working men and women who, when perceiving their right to health at work violated due to alleged or declared workplace accidents or illnesses (ATEL for its acronym in Spanish) sought support and filed one or more constitutional resources to achieve their effective restoration. Materials and methods: Mixed study. A survey was applied to 189 workers who suffered an alleged ATEL event and who sought support in the solidarity extension services at Univesidad de Antioquia or in human rights organizations in the city of Medellin. The survey that captured sociodemographic data, social security data, labor data, the Occupational Health and Safety Management System (SGSST for its acronym in Spanish) data of the background, occurrence and consequences of ATELs and legal resources interposed. For the qualitative approach, an in-depth interview was conducted with an occupational physician and an independent lawyer and four focus groups with workers who suffered ATELs, trade unionists, lawyers and doctors representing the Occupational Risk Administrator (ARL for its acronym in Spanish), and academicians. Results: the most vulnerable workers were the most affected in their right. The agents that make up the General System of Occupational Risks (SGRL by its acronym in Spanish) make a fragmented approach to health and work that facilitates the violation of the right. Workers suffering from ATEL must face economic, administrative and access to health barriers to restore their right. Conclusions: Decent and respectable work is a horizon towards which efforts should be aimed so that the most historically vulnerable workers conquer and sustain full, dignified and healthy life. Resources such as guardianship action contribute to the fulfillment of the right to health at work.
Objetivo: descrever a problemática de homens e mulheres trabalhadores que ao perceber vulnerado seu direito à saúde no trabalho por sofrer presuntos ou declarados ATEL, procuraram apoio e interpuseram um ou mais recursos constitucionais para lograr seu restabelecimento efetivo. Materiais e métodos: estudo misto. Aplicou se enquete a 189 trabalhadores que sofreram um presunto ou reconhecido evento de ATEL e que buscaram apoio nos serviços de extensão solidaria da Universidade de Antioquia ou em organizações de diretos humanos em Medellín. A enquete captou dados sócios demográficos, de segurança social, laborais, do SGSST, dos antecedentes, ocorrência e consequências dos ATEL e os recursos interpostos. Para a abordagem qualitativa se realizou: i) uma entrevista em profundidade com um médico laboral e advogado independente e ii) quatro grupos focais com trabalhadores que sofreram ATEL, sindicalistas, advogados e médicos representantes de ARL, acadêmicos. Resultados: os trabalhadores mais vulneráveis foram os mais afetados em seu direito. Os agentes que integram o SGRL fazem uma abordagem fragmentada da saúde e o trabalho que facilita a vulneração do direito. Os trabalhadores que sofrem ATEL devem enfrentar barreiras econômicas, administrativas e de aceso a saúde para restituir seu direito. Conclusões: o trabalho decente e digno é um horizonte para o qual se devem apontar os esforços para que os trabalhadores mais vulnerados historicamente conquistem e sustenham uma vida plena, digna e saudável. Os recursos como a ação de mandato de segurança que contribui a obter o cumprimento do direito à saúde no trabalho.
Assuntos
Humanos , Saúde Ocupacional , Vulnerabilidade em Saúde , Direito à SaúdeRESUMO
ABSTRACT Objective: to identify the attitudes and actions of health professionals in health promotion before the HIV/AIDS epidemic in Primary Health Care (PHC), Punta Arenas, Magallanes and Chilean Antartica Chilena region, Chile. Method: a qualitative, descriptive, and exploratory study carried out at PHC facilities in the city of Punta Arenas, Chile. Sixteen professionals who work in the five Family Health Centers participated. Data collection was carried out between March and May 2019. Data was obtained through a semi-structured interview. To organize data, ATLAS ti® was used, which were analyzed according to thematic content analysis. Results: two categories have emerged. The first category, Health promotion and prevention actions before HIV/AIDS, described the actions carried out by nurses in their daily work, such as counseling on STI/AIDS prevention, sexual/reproductive health and education for professionals and the community. The second category, Nurse-midwives' attitudes towards caring for people living with HIV/AIDS, includes caring without prejudice, active behavior and empathy due to high workload. Conclusion: health promotion and prevention actions carried out by PHC professionals are mainly related to counseling and education for professionals and the community. The need to integrate prevention measures with other professionals and vulnerable groups in the community stands out.
RESUMO Objetivo: identificar as atitudes e ações dos profissionais de saúde na promoção da saúde frente à epidemia de HIV/Aids na Atenção Primária de Saúde, Punta Arenas, região de Magalhães e Antártica Chilena, Chile. Método: estudo de enfoque qualitativo, descritivo, exploratório, realizado em estabelecimentos de Atenção Primária de Saúde da cidade de Punta Arenas, Chile. Participaram 16 profissionais que atuam nos cinco Centros de Saúde da Família. A coleta de dados foi realizada entre março e maio de 2019. Os dados foram obtidos através de entrevista semiestruturada. Foi utilizado o ATLAS-ti® para a organização dos dados, e estes foram analisados segundo a análise de conteúdo temática. Resultados: resultou em duas categorias. A primeira categoria, Ações de promoção da saúde e prevenção frente ao HIV/Aids descreve as ações realizadas pelas enfermeiras em seu trabalho diário, como o aconselhamento em prevenção de IST/Aids, saúde sexual/reprodutiva e a educação para profissionais e a comunidade. A segunda categoria, Atitudes das enfermeiras e parteiras frente à atenção de pessoas vivendo com HIV/Aids, abarca cuidar sem preconceitos, com escuta ativa e empatia diante da alta carga de trabalho. Conclusão: as ações de promoção da saúde e prevenção realizadas pelos profissionais de Atenção Primária de Saúde se relacionam principalmente com o aconselhamento e educação para profissionais e comunidade. Destaca a necessidade de transversalizar as medidas de prevenção a outros profissionais e grupos vulneráveis da comunidade.
RESUMEN Objetivo: identificar las actitudes y acciones de los profesionales de la salud en promoción de la salud frente a epidemia del VIH/SIDA en Atención Primaria de Salud, Punta Arenas, región de Magallanes y Antártica Chilena, Chile. Método: estudio de enfoque cualitativo, descriptivo, exploratorio, realizado en establecimientos de Atención Primaria de Salud de la ciudad de Punta Arenas, Chile. Participaron 16 professionales que desempeñan en los cinco Centros de Salud Familiar. La recolección de datos se realizó entre marzo y mayo de 2019. Los datos fueron obtenidos a través de entrevista semiestructurada. Para la organización de los datos, se utilizó ATLAS ti®, los cuáles fueron analizados según a análisis de contenido temática. Resultados: se obtuvo como resultados dos categorías. La primera categoría, Acciones de promoción de la salud y prevención frente al VIH/SIDA, describiu las acciones que realizan las enfermeras en su trabajo diario, como la consejería en la prevención de ITS/SIDA, salud sexual/reproductiva y la educación para profesionales y la comunidad. La segunda categoría, Actitudes de las enfermeras y matronas frente a la atención de personas viviendo con VIH/SIDA, inclue atender sin preconceitos, com escuta activa e empatía diante da alta carga laboral. Conclusión: las acciones de promoción de la salud y prevención realizadas por los profesionales de Atención Primaria de Salud se relacionan principalmente con la consejería y educación para profesionales y comunidad. Destaca la necesidad de transversalizar las medidas de prevención a otros profissionales y grupos vulnerables de la comunidad.
Assuntos
Humanos , Prevenção Primária , Síndrome da Imunodeficiência Adquirida , HIV , Enfermagem , Pessoal de Saúde , Promoção da SaúdeRESUMO
BACKGROUND: Copper mining installations in Chile use a large number of workers who do their jobs at high altitudes, exposing them to the conditions of chronic intermittent hypobaric hypoxia. The Chilean Safety Association implements the surveillance program. OBJECTIVE: This organization, under the sponsorship of the Chilean Superintendency of Social Security, was interested in determining the costs involved in this program to support its decision-making processes and to improve its performance. METHODS: Direct operating costs of the Hypoxia Medical Surveillance Program were determined through on-site surveys applied to the organization's local agencies in charge. The microcosting method was used, quantifying personnel costs, consumables, and equipment and overhead costs. Time-driven activity-based costing was partially adapted for the allocation of personnel and equipment costs. Costs concerning activities, groups of activities and items, and average cost per exposed worker were determined. RESULTS: The annual costs of the program were $127 299.58. The highest costs corresponded to the assessment activities, which were $89 192.13, representing 60.06% of the total. The labor factor costs were $77 568.50, which represents 60.93% of the total. The average cost per worker in the program is $21.17. CONCLUSIONS: The partial adaptation of the time-driven activity-based costing method in combination with the microcosting method provides a suitable solution to determine the total costs of running a healthcare program of this kind. The information generated by this study will aid in the decision-making and management processes of the Hypoxia Medical Surveillance Program.
Assuntos
Doença da Altitude/economia , Cobre , Custos de Cuidados de Saúde/estatística & dados numéricos , Mineração/economia , Doenças Profissionais/economia , Medicina do Trabalho/economia , Doença da Altitude/epidemiologia , Doença da Altitude/etiologia , Doença da Altitude/prevenção & controle , Chile/epidemiologia , Humanos , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Medicina do Trabalho/métodos , Fatores de TempoRESUMO
PURPOSE: To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile. METHODS: A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings. RESULTS: Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state. CONCLUSION: Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (â¼$19 000), CR is highly cost-effective for the public health system in Chile.
Assuntos
Síndrome Coronariana Aguda/reabilitação , Reabilitação Cardíaca/economia , Terapia por Exercício/economia , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Síndrome Coronariana Aguda/economia , Reabilitação Cardíaca/métodos , Chile/epidemiologia , Análise Custo-Benefício , Terapia por Exercício/métodos , Humanos , IncidênciaRESUMO
OBJECTIVE: To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. STUDY DESIGN AND SETTING: Cost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. RESULTS: The ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US$). In the budget impact analysis for the baseline scenario, considering 100% of treatment, coverage, and adherence, ticagrelor represented an additional cost of CLP 5,233,854,272, for 979 QALYs gained compared with clopidogrel. CONCLUSIONS: Ticagrelor is cost-effective in comparison with clopidogrel for the secondary prevention of acute coronary syndrome. These findings are similar to those reported in other international cost-effectiveness studies.
Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Adenosina/análogos & derivados , Análise Custo-Benefício/economia , Ticlopidina/análogos & derivados , Adenosina/economia , Adenosina/uso terapêutico , Idoso , Clopidogrel , Estudos Epidemiológicos , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Antagonistas do Receptor Purinérgico P2Y/economia , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ticagrelor , Ticlopidina/economia , Ticlopidina/uso terapêuticoRESUMO
OBJECTIVE: Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. The objective of this study was to assess the incremental cost-utility ratio (ICUR) for apixaban vs. acenocoumarol in patients treated in Chile's public health system. STUDY DESIGN AND SETTING: We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature. RESULTS: Incremental costs when using apixaban vs. acenocoumarol over a lifetime are CH$2,108,600 with an incremental effectiveness of 0.173 years of life gained (YLG) and 0.182 quality-adjusted life-year (QALY). The ICUR of apixaban vs. acenocoumarol was CH$12,188,439 per YLG and CH$11,585,714 per QALY. One to 3 times gross domestic product (GDP) per capita threshold is acceptable based on World Health Organization (WHO) norms. Chilean GDP per capita was CH$7,797,021 in 2013. The sensitivity analysis shows that these results are sensitive to the ischemic stroke risk with apixaban, and the intracranial hemorrhage risk due to the use of acenocoumarol. CONCLUSION: The use of apixaban in patients with NVAF in moderate-to-high risk of stroke is cost-effective, considering the payment threshold suggested by WHO.
Assuntos
Acenocumarol/economia , Acenocumarol/uso terapêutico , Fibrilação Atrial/complicações , Pirazóis/economia , Pirazóis/uso terapêutico , Piridonas/economia , Piridonas/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Idoso , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Chile , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricos , Estudos Epidemiológicos , Inibidores do Fator Xa/economia , Inibidores do Fator Xa/uso terapêutico , Feminino , Humanos , América Latina , Masculino , RiscoRESUMO
Durante las últimas décadas, una considerable atención científica ha sido puesta en la seguridad de los fluoruros, dada la amplia variedad de fuentes de ingestión a la que la población se encuentra expuesta y los riesgos a la salud de las personas que esto puede acarrear. El objetivo de esta investigación fue determinar si la fluoración del agua a concentraciones de 0,6 a 1 ppm se asocian a una mayor proporción de efectos adversos en la población general al compararlo con concentraciones subóptimas. Se realizó una revisión sistemática de la literatura en MEDLINE, EMBASE, COCHRANE, SCIELO, LILACS, CRD, BBO, PAHO y WHOLIS, limitada desde el 2002 al 2012. Se incluyeron estudios primarios y secundarios en español, inglés y portugués con al menos dos poblaciones comparadas, una con niveles óptimos de flúor en agua (0,61 ppm) y otra sin fluoración del agua (<0,3 ppm) o con niveles subóptimos (>0,3 < 0,6 ppm). Dos investigadores de forma independiente realizaron evaluación de la calidad de los artículos seleccionados y que cumplieron los criterios de inclusión. La búsqueda arrojó 1024 artículos de los cuales 24 cumplieron los criterios de inclusión y 10 fueron incluidos como evidencia. Con excepción de fluorosis dental, no hay asociación entre fluoración del agua con fracturas óseas, cáncer u otro efecto adverso. A pesar de la mayor prevalencia de fluorosis en zonas fluoradas, esta fue principalmente del tipo cuestionable a leve y la proporción de fluorosis con daño estético no difiere significativamente de la presente en zonas sin fluoración del agua.
During the last decades, considerable scientific attention has been paid to the safety of fluoride, given the wide variety of sources of intake at which the population is exposed and the risks to the health of people this may produce. The aim was to determine whether water fluoridation at concentrations from 0.6 to 1 ppm is associated with a higher proportion of adverse effects in the general population when comparing them to suboptimal concentrations. A systematic review was conducted of the literature in MEDLINE, EMBASE, COCHRANE, SCIELO, LILACS, CRD, BBO, PAHO and WHOLIS, limited to 2002 to 2012. Included were primary and secondary studies in Spanish, English and Portuguese with at least two compared populations, one with optimal fluoride levels in the water (0.61 ppm) and another without water fluoridation (<0.3 ppm) or with suboptimal levels (>0.3 < 0.6ppm). Two researchers independently evaluated the quality of the articles selected and which met the inclusion criteria. The search revealed 1024 articles, of which 24 met the inclusion criteria and 10 were included as evidence. With the exception of dental fluorosis, there is no association between any other adverse effect and water fluoridation. Despite the greater prevalence of fluorosis in fluoride than in non-fluoride zones, this was mainly questionable to slight and the proportion of fluorosis with esthetic damage does not differ significantly from this in zones without water fluoridation.
Assuntos
Humanos , Água , Fluoretação/efeitos adversos , Fraturas Ósseas/complicações , Fluoretos/farmacologia , Fluorose Dentária/complicaçõesRESUMO
This article reviews the most relevant methodological aspects involved in Health Technology Assessment (HTA). Firstly, it addresses the process of defining the research problem (or scoping). Then it explains some specific aspects of systematic reviews of evidence, as well as indirect and mixed comparisons of the effectiveness of interventions. It covers also the methods for economic evaluation in healthcare and the budget impact analysis of interventions. Finally, the paper provides an empirical insight on the methodological emphasis used by HTA agencies around the world, and reflects on the available capacities in our country in the topics discussed.
Assuntos
Avaliação da Tecnologia Biomédica/métodos , Análise Custo-Benefício , Medicina Baseada em Evidências , Humanos , Avaliação da Tecnologia Biomédica/economiaRESUMO
This article reviews the most relevant methodological aspects involved in Health Technology Assessment (HTA). Firstly, it addresses the process of defining the research problem (or scoping). Then it explains some specific aspects of systematic reviews of evidence, as well as indirect and mixed comparisons of the effectiveness of interventions. It covers also the methods for economic evaluation in healthcare and the budget impact analysis of interventions. Finally, the paper provides an empirical insight on the methodological emphasis used by HTA agencies around the world, and reflects on the available capacities in our country in the topics discussed.
Assuntos
Humanos , Avaliação da Tecnologia Biomédica/métodos , Análise Custo-Benefício , Medicina Baseada em Evidências , Avaliação da Tecnologia Biomédica/economiaRESUMO
Introduction. Rheumatoid arthritis patients under treatment with anti-TNF-α are at a high risk of developing active tuberculosis, and therefore, screening for latent tuberculosis infection is recommended before anti-TNF-α therapy. Objective. To compare the tuberculin test and IFNγ production induced by culture filtrate proteins(CFPs) and Mycobacterium tuberculosis-specific CFP-10 antigens in rheumatoid arthritis patients. Materials and methods. An analytic transversal study was conducted in rheumatoid arthritis patients treated at Hospital Universitario San Vicente Fundación between January and December 2007. IFNγ production in response to CFPs and CFP-10 was measured in the supernatants of whole blood cultures and evaluated for correlations with tuberculin reactivity. The degree of concordance between both tests was also established. Results. Forty-five patients were included, of which 14 (31.1%) had a tuberculin reaction of ≥10 mm of induration, 9 (20%) produced IFNγ in response to CFP-10, and 7 were positive for both tests. The correlation between tests was r=0.53 (IC 95%:0.28-0.72), and the global concordance between tests was80%, with a Kappa coefficient of 0.48 (IC95%:0.20-0.76). Conclusions. Only two tuberculin (-)/CFP-10+ "anergic" patients were observed. By contrast, six tuberculin +/CFP-10(-) "tuberculin false-positive" patients were observed. These data suggest that the tuberculin test is not an appropriate tool for determining the need for tuberculosis prophylaxis.
Introducción. Los pacientes con artritis reumatoide bajo tratamiento con anti-TNFα están en alto riesgo de desarrollar tuberculosis activa, por lo cual se recomienda hacer la tamización para infección latente de tuberculosis, antes de iniciar el tratamiento. Objetivo. Comparar la prueba de tuberculina y la producción de IFNγ inducida por antígenos CFP (Culture Filtrate Protein) y antígenos específicos de Mycobacterium tuberculosis (CFP-10) para el diagnóstico de infección latente de tuberculosis en pacientes con artritis reumatoide. Materiales y métodos. Se llevó a cabo un estudio transversal analítico en pacientes con artritis reumatoide atendidos en el Hospital Universitario San Vicente Fundación, entre enero y diciembre de 2007, a los cuales se les determinó la producción de IFNγ en respuesta a CFP y CFP-10 en sobrenadantes de cultivos de sangre total, y se correlacionó con la reacción en la prueba de tuberculina. Además, se estableció el grado de concordancia entre ambas pruebas. Resultados. Se incluyeron 45 pacientes, de los cuales, 14 (31,1 %) tuvieron un diámetro de induración ≥10 mm (tuberculina positiva), nueve (20 %) produjeron IFNγ en respuesta a CFP-10, y siete fueron positivos para ambas pruebas. La correlación entre las pruebas fue de r=0,53 (IC95%: 0,28-0,72) y la concordancia global entre pruebas fue de 80 %, con un coeficiente kappa de 0,48 (IC95%: 0,20-0,76). Conclusiones. Solo se observaron dos pacientes con tuberculina positiva y CFP-10 positivo "anérgicos" y se encontraron seis pacientes con tuberculina positiva y CFP-10 negativa "falsos positivos para tuberculina", lo cual sugiere que la prueba de la tuberculina no es la más adecuada para indicar profilaxis para tuberculosis.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antígenos de Bactérias/farmacologia , Artrite Reumatoide/sangue , Artrite Reumatoide/imunologia , Teste Tuberculínico , Tuberculose/sangue , Tuberculose/diagnóstico , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Artrite Reumatoide/complicações , Células Cultivadas , Colômbia , Estudos Transversais , Tuberculose/complicaçõesRESUMO
INTRODUCTION: Rheumatoid arthritis patients under treatment with anti-TNF-α are at a high risk of developing active tuberculosis, and therefore, screening for latent tuberculosis infection is recommended before anti-TNF-α therapy. OBJECTIVE: To compare the tuberculin test and IFNγ production induced by culture filtrate proteins(CFPs) and Mycobacterium tuberculosis-specific CFP-10 antigens in rheumatoid arthritis patients. MATERIALS AND METHODS: An analytic transversal study was conducted in rheumatoid arthritis patients treated at Hospital Universitario San Vicente Fundación between January and December 2007. IFNγ production in response to CFPs and CFP-10 was measured in the supernatants of whole blood cultures and evaluated for correlations with tuberculin reactivity. The degree of concordance between both tests was also established. RESULTS: Forty-five patients were included, of which 14 (31.1%) had a tuberculin reaction of ≥10 mm of induration, 9 (20%) produced IFNγ in response to CFP-10, and 7 were positive for both tests. The correlation between tests was r=0.53 (IC 95%:0.28-0.72), and the global concordance between tests was80%, with a Kappa coefficient of 0.48 (IC95%:0.20-0.76). CONCLUSIONS: Only two tuberculin (-)/CFP-10+ "anergic" patients were observed. By contrast, six tuberculin +/CFP-10(-) "tuberculin false-positive" patients were observed. These data suggest that the tuberculin test is not an appropriate tool for determining the need for tuberculosis prophylaxis.
Assuntos
Antígenos de Bactérias/farmacologia , Artrite Reumatoide/sangue , Artrite Reumatoide/imunologia , Teste Tuberculínico , Tuberculose/sangue , Tuberculose/diagnóstico , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Adulto , Artrite Reumatoide/complicações , Células Cultivadas , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose/complicaçõesRESUMO
OBJECTIVE: To evaluate and compare the costs and effectiveness of two alternative stent, drug eluting stent (SF) and bare metal stent (SNF). MATERIAL AND METHODS: Cost-utility analysis based on a Markov model using data from a cohort study of Hospital Las Higueras of Talcahuano, Chile. The effectiveness measure was the rate of restenosis and the time of restenosis. The effectiveness outcomes are expressed in quality-adjusted life years (QALY) gained. Costs are expressed in national currency 2011. The evaluation perspective was from the public heath budget. We model a cohort from age 63 to 80 years, life expectancy in Chile. Apply discount rate of 0, 3% and 6% for results and costs. Sensitivity analysis is performed according to the ranges of variability in costs, the utility values of the variables and transition between states. RESULTS: No differences in restenosis rates between the two stents, although there were differences in the time of restenosis. The incremental cost effectiveness ratio (ICER) no discount rate was CH$ 235.749 per QALY gained when using drug-eluting stent, the value below the equivalent of 1 Gross Domestic Product (PIB) per capita for 2011 in Chile. CONCLUSIONS: The drug-eluting stent (SF) is cost effective compared to bare metal stent (SNF). The ICER is not affected by the sensitivity analysis (variability of cost, utility ranges used, probability of restenosis).
RESUMO
BACKGROUND: Mycosphaerella fijiensis Morelet causes black sigatoka, the most important disease in bananas and plantains. Disease control is mainly through the application of systemic fungicides, including sterol demethylation inhibitors (DMIs). Their intensive use has favoured the appearance of resistant strains. However, no studies have been published on the possible resistance mechanisms. RESULTS: In this work, the CYP51 gene was isolated and sequenced in 11 M. fijiensis strains that had shown different degrees of in vitro sensitivity to propiconazole, one of the most widely used DMI fungicides. Six mutations that could be related to the loss in sensitivity to this fungicide were found: Y136F, A313G, Y461D, Y463D, Y463H and Y463N. The mutations were analysed using a homology model of the protein that was constructed from the crystallographic structure of Mycobacterium tuberculosis (Zoff.) Lehmann & Neumann. Additionally, gene expression was determined in 13 M. fijiensis strains through quantitative analysis of products obtained by RT-PCR. CONCLUSION: Several changes in the sequence of the gene encoding sterol 14alpha-demethylase were found that have been described in other fungi as being correlated with resistance to azole fungicides. No correlation was found between gene expression and propiconazole resistance.
Assuntos
Ascomicetos/genética , Sistema Enzimático do Citocromo P-450/genética , Farmacorresistência Fúngica/genética , Proteínas Fúngicas/genética , Genes Fúngicos , Triazóis/farmacologia , Sequência de Aminoácidos , Ascomicetos/fisiologia , Domínio Catalítico , Sistema Enzimático do Citocromo P-450/química , Proteínas Fúngicas/química , Regulação Fúngica da Expressão Gênica , Modelos Moleculares , Dados de Sequência Molecular , Mutação , Homologia de Sequência , Esterol 14-DesmetilaseRESUMO
La presente investigación tiene como objetivo verificar la condición microbiológica de conos de gutapercha estandarizados y no estandarizados distribuidos por los depósitos dentales del área de san salvador. Fueron analizados 36 conos de gutapercha de las marcas comerciales Henry Schein, Endotek, Hygienic, New Stetic, Dentsply y Kerr. A través de la inmersión de los conos de tubos de ensayo conteniendo cal de tripticasa soya incubados a 37°C por 24 horas. Los resultados no mostraron proliferación bacteriana en el medio del cultivo por lo que los conos de gutapercha evaluados no estaban contaminados. En base al estudio los conos de gutapercha evaluados presentan condiciones asépticas para su uso.
The present research aims to verify the microbiological condition of standardized and non-standardized gutta-percha cones distributed by dental deposits in the San Salvador area. 36 gutta-percha cones from the Henry Schein, Endotek, Hygienic, New Stetic, Dentsply and Kerr trademarks were analyzed. Through immersion of test tube cones containing soybean trypticase lime incubated at 37 ° C for 24 hours. The results did not show bacterial proliferation in the culture medium, so the evaluated gutta-percha cones were not contaminated. Based on the study, the evaluated gutta-percha cones present aseptic conditions for their use.
Assuntos
Guta-Percha , Materiais Dentários , El Salvador , EndodontiaRESUMO
La reticulohistiocitosis multicéntrica (RHM) es una enfermedad de etiología desconocida que afecta principalmente a mujeres en la cuarta década de la vida. La afección articular se caracteriza por la presencia de sinovitis simétrica de miembros superiores especialmente en manos y afección de piel presentando lesiones de diferente morfología más comúnmente nódulos y pápulas localizadas principalmente en cara y miembros superiores. Puede existir además compromiso de órganos internos como pulmón, corazón, tracto gastrointestinal y glándulas salivales. Esta patología se ha relacionado con la aparición de neoplasias malignas en diferentes órganos como mama, ovario, cérvix y linfomas llegando a ser considerada por diferentes autores como una manifestación de un síndrome paraneoplásico. Los exámenes de laboratorio en estos pacientes evidencian alteraciones en el cuadro hemático, perfil hepático así como marcadores de autoinmunidad. El diagnóstico confirmatorio de la enfermedad se determina por el estudio histológico donde se demuestran células histiocíticas (histiocitos mononucleares) gigantes multinucleadas (con diámetro de 50-100 µm) con citoplasma eosinofílico y gránulos finos con apariencia de vidrio esmerilado. Múltiples medicamentos han sido usados como ciclofosfamida, metotrexate, azatioprina, clorambucil y regímenes conjugados. Se informa el caso de una paciente de sexo femenino de 51 años, raza blanca, que consulta por cuadro clínico de cuatro meses de evolución caracterizado por astenia, adinamia, fiebre subjetiva nocturna, pérdida de peso, poliartritis inflamatoria de carpos, codos y rodillas, así como la aparición de lesiones cutáneas en forma de pápulas dolorosas de color violáceo que se localizaban en cara, codos, manos y flancos.
Multicentric reticulohistiocytosis (MRH) is a disease of unknown etiology that affects primarily women in the fourth decade of life. Articular involvement is characterized by the presence of symmetric synovitis of the upper extremities, particularly of the hands, and compromise of the skin with lesions of different morphology, more commonly nodules and papules localized mainly on the face and upper extremities. There can also be involvement of internal organs such as lung, heart, gastrointestinal tract and salivary glands. This disease has been linked to malignant neoplasms of different organs like breast, ovary, uterine cervix and lymphomas, leading some authors to consider this disease a manifestation of a paraneoplastic syndrome. Laboratory testing in these patients show abnormalities of the complete blood count, liver function tests as well as markers of autoimmunity. Histological studies confirm the diagnosis by demonstrating giant multinucleated histiocytic cells (mononuclear histiocytes-diammeter of 50 to 100 µm) with an eosinophilic cytoplasm and fine granules that give the cells a ground glass appearance. Multiple medications have been used to treat this disease including cyclophosphamide, azathioprine, methotrexate, chlorambucil and combined regimens. We document the case of a 51 year old caucasian female patient that was evaluated because of a 4 month history of subjective fever, weakness, fatigue, weight loss, inflammatory bilateral polyarthritis of the wrists, elbows and knees as well as the appearance of painful violaceous papules on the surface of the face, elbows, hands and flanks.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Mulheres , Histiocitose , Pessoa de Meia-Idade , Pacientes , Preparações Farmacêuticas , Autoimunidade , DiagnósticoRESUMO
La tuberculosis es un problema de salud pública y se hace necesario contar con métodos de laboratorio que permitan apoyar su diagnóstico oportuno. A pesar de las diferencias reportadas en cuanto a sensibilidad y especificidad de la técnica para la determinación de la enzima adenosina deaminasa, su medición se ha utilizado en el diagnóstico de tuberculosis extrapulmonar, ya que participa principalmente en el catabolismo de las purinas en la diferenciación y proliferación linfocítica que se presentan como respuesta ante antígenos micobacterianos. El objetivo de este estudio fue estandarizar la técnica para la medición de adenosina deaminasa en líquidos de cavidades estériles, así como analizar los factores que podrían afectar el resultado final. Con este fin se recolectaron 100 muestras de líquidos de cavidades estériles, con diferentes aspectos y condiciones de almacenamiento. Para su análisis se empleó la técnica que recomienda el Instituto Nacional de Salud, institución que realizó el control externo del proceso. Se logró estandarizar la técnica con resultados similares a los obtenidos en el Instituto Nacional de Salud. Se concluyó que el utilizar muestras almacenadas por más de 24 horas a temperaturas inferiores a -20°C, turbias o purulentas de las que se aisle algún microorganismo diferente a Mycobacterium tuberculosis, o que presenten algún grado de hemólisis afectan los valores finales de la enzima y podrían aumentar el porcentaje de falsos positivos para tuberculosis.Palabras clave: adenosina deaminasa, tuberculosis, técnica, muestras, control de calidad.