Costo efectividad de la cirugía reductora de riesgo en trompas y ovarios en casos con mutación del gen BRCAI en Colombia / Cost-effectiveness of risk-reducing salpingo-oophorectomy in cases of BRCA1 gene mutation in Colombia

RESUMEN Objetivo Evaluar la utilidad de la cirugía reductora de riesgo en trompas y ovarios en casos con mutación del gen BRCA1 en Colombia Material y Métodos Análisis de costo-efectividad en el que se incorporan tres procesos: a. Pacientes con pruebas de tamización para cáncer de mama y ovario. b. cirugía reductora de riesgo en trompas y ovarios c. cirugía reductora de riesgo en trompas y ovarios con mastectomía bilateral. Se evalúa como desenlace la ganancia en años de supervivencia. Resultados La cohorte con cirugía reductora de riesgo en trompas y ovarios y mastectomía bilateral es la de mayor ganancia con 13 años mientras que la cirugía reductora de riesgo en trompas y ovarios gana 4,95 años con respecto al grupo de seguimiento. Conclusiones Las tres opciones evaluadas son aceptables, pero de ellas la de mayor ganancia en la supervivencia es la combinación de cirugía reductora de riesgo en trompas y ovarios con mastectomía bilateral.(AU)

ABSTRACT Objective To assess the usefulness of risk reduction salpingo-oophorectomy in cases with mutation of the BRCA1 gene in Colombia. Material and Methods Cost-effectiveness analysis in which three processes are incorporated: a. Patients with screening tests for breast and ovarian cancer. b. Risk reduction surgery in the fallopian tubes and ovaries c. Reductive surgery in the fallopian tubes and ovaries with bilateral mastectomy. The outcome is evaluated as the gain in years of survival. Results The cohort with risk reduction surgery in the fallopian tubes and ovaries and bilateral mastectomy is the one with the highest gain with 13 years, while the risk reduction surgery in the fallopian tubes and ovaries gain 4.95 years with respect to the follow-up group. Conclusions The three options evaluated are acceptable, but of them the one with the greatest gain in survival is the combination of risk-reducing surgery in the fallopian tubes and ovaries with bilateral mastectomy.(AU)

Avaliação do reparo ósseo na interface osso/implante em ratas com osteoporose induzida tratadas com raloxifeno ou alendronato: análise histométrica, imunoistoquímica, por epifluorescência e biomecânica / Bone repair evaluation in bone/implant interface in rats with induced osteoporosis treated with raloxifene or alendronate: histometric. immunohistochemistry, epifluorescence and biomechanical analysis

O objetivo deste estudo foi avaliar o reparo ósseo na interface osso/implante em ratas com osteoporose induzida. As ratas submetidas à ovariectomia bilateral foram alimentadas com uma dieta pobre em cálcio. Dois grupos receberam tratamento medicamentoso (raloxifeno [OVX RAL] ou alendronato [OVX ALE]) e outro grupo não recebeu nenhuma medicação (OVX ST). O grupo controle foi submetido à cirurgia fictícia e foi alimentado com uma dieta normal (SHAM DN). Cada animal recebeu um implante em cada tíbia. Os animais foram eutanasiados após 14 ou 42 dias. Foram realizadas as análises biomecânica (torque reverso), extensão linear de contato osso/implante (ELCOI) e dinâmica óssea periimplantar pela proporção dos fluorocromos calceína/alizarina, aplicando-se a análise de variância ANOVA e o pós-teste de Tukey (p<0,05). A imunoistoquímica marcou a precipitação de osteoprotegerina (OPG), RANKL, TRAP e osteocalcina (OC). O medicamento RAL melhorou o reparo ósseo periimplantar, em que o grupo ALE foi semelhante ao grupo OVX ST. Não houve diferenças estatisticamente significativas no torque reverso (p = 0,861), na precipitação dos fluorocromos (calceína/alizarina) e na ELCOI entre os grupos OVX RAL e grupo controle - SHAM DN (p > 0,05). As imunomarcações de OPG e RANKL foram similares para os grupos RAL e SHAM; houve moderada expressão de OC aos 14 dias. A TRAP foi marcada intensamente aos 42 dias para o grupo OVX. Portanto, o raloxifeno melhorou o reparo ósseo periimplantar de ratas osteoporóticas, sugerindo a sua indicação no tratamento da osteoporose.

The aim of this study was to evaluate the bone healing in bone/implant interface in rats with induced osteoporosis. The rats underwent bilateral ovariectomy were fed a diet low in calcium. Two groups received drug treatment (raloxifene [OVX RAL] or alendronate [OVX ALE]) and the other group received no medication (OVX NT). The control group underwent sham surgery and was fed a normal diet (SHAM ND). Each animal received an implant on the tibia. The animals were euthanized after 14 or 42 days. The biomechanical analysis (reverse torque), linear extension contact bone / implant (BIC) and bone dynamics periimplantar by the proportion of fluorochrome calcein/alizarin, applying the ANOVA and Tukey’s post-test (p<0.05). Immunohistochemistry marked precipitation of osteoprotegerin (OPG), RANKL, TRAP and osteocalcin (OC). The RAL improved drug peri-implant bone repair, wherein the ALE OVX group was similar to the ST group. There were no statistically significant differences in reverse torque (p = 0.861), precipitation of fluorochromes (calcein/alizarin) and BIC between OVX RAL and control groups - SHAM ND (p> 0.05). The immunostaining of OPG and RANKL were similar to RAL and SHAM groups; there was moderate OC expression at 14 days. TRAP was marked intensely at 42 days for the OVX group. Therefore, raloxifene improved peri-implant bone repair of osteoporotic rats, suggesting its indication in the treatment of osteoporosis.