Impacto econômico da adoção de denosumabe em pacientes com metástases ósseas ou mieloma múltiplo sob a perspectiva do sistema de saúde privado brasileiro / Economic impact of denosumab adoption in cancer patients with bone metastases or multiple myeloma from the Brazilian private healthcare system's perspective

Objetivo: Estimar o custo por evento relacionado ao esqueleto (ERE) e o impacto econômico anual da adoção de denosumabe em pacientes com metástases ósseas secundárias ao câncer de mama, próstata e outros tumores sólidos ou mieloma múltiplo sob a perspectiva do sistema de saúde privado brasileiro. Métodos: Um modelo econômico foi desenvolvido para comparar os custos relacionados com denosumabe versus ácido zoledrônico na prevenção de EREs. O modelo incluiu os seguintes custos: medicamento, administração, monitoramento e manejo de ERE. O custo anual foi apresentado em reais (BRL) para 100 pacientes. Os custos do manejo de ERE [fratura vertebral (FV), fratura não vertebral (FNV), radiação óssea (RO), cirurgia óssea (CO) e compressão da medula espinhal (CME)] foram estimados a partir dos recursos e procedimentos coletados da revisão de literatura, bases de dados e painel Delphi. Dados coletados dos estudos clínicos randomizados relacionados com cada tipo de tumor na análise e de um estudo prospectivo observacional foram utilizados para estimar a eficácia clínica de denosumabe versus ácido zoledrônico. Resultados: O custo por cada tipo de ERE variou de BRL 27.246 a BRL 28.035 para FV, BRL 18.023 a BRL 18.811 para FNV, BRL 42.750 a BRL 43.538 para RO, BRL 18.023 a BRL 18.811 para CO e BRL 12.472 a BRL 13.260 para CME. A introdução de denosumabe foi estimada em economia anual por 100 pacientes de até BRL 1.072.043,14 para câncer de mama, BRL 1.212.822,79 para outros tumores sólidos, BRL 1.929.660,67 para câncer de próstata e BRL 77.965,07 para mieloma múltiplo. Conclusão: Esta análise sugere que EREs adicionam custos substanciais no manejo de pacientes com metástases ósseas. Dessa forma, o uso de denosumabe pode prevenir e retardar EREs em pacientes com câncer e pode possivelmente levar à redução do impacto econômico associado aos EREs sob a perspectiva dos pagadores de saúde privada brasileira.

Objective: To estimate the cost per SRE and annual economic impact of denosumab adoption in patients with bone metastases (BM) secondary to breast cancer, prostate cancer, other solid tumors or multiple myeloma from the Brazilian private healthcare system's perspective. Methods: An economic model was developed to compare the cost outcomes associated with denosumab instead of zoledronic acid for SRE prevention. The model included the following costs: drug, administration, monitoring and SRE management. Annual costs per 100 patients were reported in 2019 Brazilian currency (BRL). The SRE management costs (vertebral fracture (VF), non-vertebral fracture (NVF), radiation to bone (RB), surgery to bone (SB) and spinal cord compression (SCC)) were estimated from the resources and procedures collected from literature review, official database, and a Delphi panel. Data collected from randomized clinical trials related to each tumor type in the analysis and from a prospective observational study was used to estimate the clinical efficacy of denosumab vs zoledronic acid. Results: The cost per each type of SREs across all tumors ranged BRL 27,246 ­ BRL 28,035 for VF, BRL 18,023 ­ BRL 18,811 for NVF, BRL 42,750 ­ BRL 43,538 for RB, BRL 18,023 ­ BRL 18,811 for SB and BRL 12,472 ­ BRL 13,260 for SCC. The introduction of denosumab was estimated to result in annual savings per 100 patients of up to BRL 1,072,043.14 for breast cancer, BRL 1,212,822.79 for other solid tumors, BRL 1,929,660.67 for prostate cancer and BRL 77,965.07 for multiple myeloma. Conclusion: This analysis suggests that SREs add substantial costs to the management of patients with bone metastases. In this way, the use of denosumab would prevent and delay SREs in cancer patients and might possibly lead to reduce the economic burden associated with SREs, borne by Brazilian private healthcare payers.

Niveles de orientación empática en los estudiantes de Odontología / Evaluation of empathetic orientation in Odontology students

El objetivo del presente trabajo es evaluar la orientación empática, considerando los factores curso y género, en los estudiantes de la carrera de Odontología de la Facultad de Ciencias de la Salud de la Universidad Latinoamericana de Ciencias y Tecnología (ULACIT) de Costa Rica. Se tomó una muestra de 225 estudiantes pertenecientes al equivalente de los niveles 1ro., 2do., 3ro., 4to. y 5to. de la Carrera de Odontología. Se encuestaron con una herramienta llamada Escala de Empatía para Odontólogos de Jefferson, versión S, durante una semana, un día determinado por nivel. Después de realizar el análisis estadístico se encontró que los años superiores muestran niveles de orientación empática mayores que el resto de los cursos examinados en ambos géneros. Esto se debe al aumento, en la práctica clínica, de los estudiantes al final de la carrera y a la responsabilidad y compromiso que llegan a tener con sus pacientes. Además, en general, la orientación empática es mayor en el género femenino que en el masculino y esta va evolucionando de diferente forma para ambos géneros a lo largo de la carrera(AU)

The aim of the present work is to evaluate the emphatic orientation, considering the gender and course factors, in Odontology students in the Health Sciences Faculty of the Latin American University of Sciences and Technology in Costa Rica. The sample was composed of 225 students from the 1st, 2nd, 3rd, 4th and 5th levels in Odontology Studies. They were inquired using a tool called The Jefferson Scale of Physician Empathy-Student Version (JSPE-S) during a week, a determined day per level. After carrying out the statistical analysis, it was found that the higher levels show higher levels of empathetic orientation than the rest of the courses examined in both genders. It is due to the increase of the students' clinical practice at the end of the studies and to the responsibility and commitment they achieve with their patients. Also, in general, empathetic orientation is higher in females than in males and it is evolving differently through years of studies(AU)

Intrachromosomal amplification of chromosome 21 (iAMP21) detected by ETV6/RUNX1 FISH screening in childhood acute lymphoblastic leukemia: a case report

Chromosome abnormalities that usually define high-risk acute lymphoblastic leukemia are the t(9;22)/ breakpoint cluster region protein-Abelson murine leukemia viral oncogene homolog 1, hypodiploid with < 44 chromosomes and 11q23/ myeloid/lymphoid leukemia gene rearrangements. The spectrum of acute lymphoblastic leukemia genetic abnormalities is nevertheless rapidly expanding. Therefore, newly described chromosomal aberrations are likely to have an impact on clinical care in the near future. Recently, the rare intrachromosomal amplification of chromosome 21 started to be considered a high-risk chromosomal abnormality. It occurs in approximately 2-5% of pediatric patients with B-cell precursor acute lymphoblastic leukemia. This abnormality is associated with a poor outcome. Hence, an accurate detection of this abnormality is expected to become very important in the choice of appropriate therapy. In this work the clinical and molecular cytogenetic evaluation by fluorescence in situ hybridization of a child with B-cell precursor acute lymphoblastic leukemia presenting the rare intrachromosomal amplification of chromosome 21 is described.

Evaluación de la Orientación Empática en estudiantes de odontología de la Universidad Metropolitana de Barranquilla (Colombia) / Measurement of Empathetic Orientation in dentistry students of Metropolitana University of Barranquilla (Colombia)

Objetivo: Evaluar el nivel de orientación empática de los alumnos del Programa de Odontología de la Universidad Metropolitana de Barranquilla (Colombia). Materiales y métodos: Se realizó una investigación no experimental, descriptiva, de corte transversal y ex post facto causa-efecto. La población estaba constituida por 169 estudiantes de 1°, 2°, 3°, 4° y 5° año de odontología de la Universidad Metropolitana de Barranquilla, a quienes se les aplicó la Escala de Empatia Médica de Jefferson (EEM). Los datos primarios obtenidos fueron sometidos a la prueba de normalidad de Shapiro-Wilk en los dos factores Año y Sexo y a la prueba de homocedasticidad de Levene. Se compararon las medias mediante un Análisis de Varianza Bifactorial Modelo III con interacción de primer orden. Se estimó la potencia observada y el tamaño del efecto. Resultados: Hay diferencias entre cursos y no entre géneros. Las medias en los cuatro primeros cursos son iguales entre sí pero todas difieren con la media del quinto año, que muestra un incremento de la empatía. Los niveles de orientación empática mostraron valores por encima del valor central del rango de la escala, que oscila entre 20 y 140. Conclusiones: Los resultados obtenidos muestran que la variable estudiada cambia entre los distintos cursos de la carrera. No se observa diferencias entre los géneros. El comportamiento de la variable refleja en las mujeres una "menor" estabilidad, con una leve tendencia a aumentar en el tiempo; en los hombres manifiesta variaciones más estables.

Objectives: To assess the level of empathetic orientation of the dentistry students at the Metropolitan University (Barranquilla, Colombia) . Subjects and methods: This study is based on a non-experimental, descriptive, cross-sectional research. 169 students of the Dentistry School of Metropolitan University who belonged to 1°, 2°, 3°, 4° and 5° levels participated in the study. The Jefferson Scale of Physician Empathy was applied. The Shapiro-Wilk normality test and homocedasticity Levene test were performed for the data analysis. Descriptive statistician statigraphs were considered in all the studiedfactors. Finally, average comparison mean was made through a Bifactorial analysis of variance. Results: There were significant differences between the different levels but not in regard to gender. The both variables behaved independently of each other. Means in the first four years are equal to each other but they all differ from the average of the fifth year, showing an increase of empathy. The levels of empathic orientation showed values located above the central value of the scale range between 20 and 140. Conclusion: The results show that the dependent variable changes between different levels. No gender differences were observed. However, the variable behavior in women reflects a "lower" stability with a slight tendency to increase over time, whereas men expressed more stable variations.

Evaluación del nivel de orientación empática en estudiantes de Odontologia / Measurement of empathetic orientation in Dentistry students

Objetivo: Evaluar el nivel de orientación empática en los alumnos de la Facultad de Odontologia de la Universidad Finis Terrae. Materiales y Métodos: Se realizó un estudio no experimental, descriptivo, transversal y ex post facto causa-efecto. Participaron 136 alumnos, de un universo de 183, correspondientes a los niveles 3°, 4° y 5° de la Facultad de Odontologia de la Universidad Finis Terrae (Chile) en 2009, a quienes se aplicó la Escala de Empatia Médica de Jefferson (EEMJ). Para el análisis de los datos obtenidos se realizó la prueba de normalidad de Shapiro-Wilk y la prueba de Levene de homocedasticidad. Posteriormente se estimaron los estadígrafos descriptivos en todos los factores estudiados, y finalmente la comparación de las medias se realizó mediante un Análisis de Varianza Bifactorial y una prueba de comparación multiple de Duncan. Resultados: Los puntajes obtenidos en la (EEMJ) son mayores en los niveles más avanzados de la carrera. Las mujeres presentan puntuaciones más altas que los hombres en los distintos niveles estudiados. Los hombres presentan mayores incrementos en los puntajes obtenidos en los mismos niveles evaluados. Conclusiones: Los estudiantes de odontologia de los niveles 3°, 4° y 5° de la Universidad Finis Terrae presentan un alto nivel de orientación empática. En las mujeres se presentan menos cambios en los niveles evaluados; en cambio, los hombres presentan un mayor desarrollo de su nivel de orientación empática.

Objetives: To know the empathetic orientation of the dentistry students of Finis Terrae University. Subjects and Methods: This work is a non experimental, descriptive, cross-sectional research. 136 out of 183 students participated who belonged to levels 3°, 4° y 5° of the School Dentistry of Finis Terrae University (Chile) in 2009. The Jefferson Scale of Physician Empathy empathy was applied. The Shapiro-Wilk normality test and homocedasticidad Levene homocedasticity Levene test was were performed for the analysis of the data obtained. Subsequently, considered descriptive statisticians descriptive statigraphs were considered in all the studied factors and finally average comparison comparing mean was made through an Bifactorial analysis of variance Bifactorial and a test Duncan multiple comparison test of Duncan. Results: Higher scores in the JSPE was were obtained in fourth and fifth levels. Women"s had higuer higher empathy scores than men"s, and men"s had more development in empa-thetic scores in the evaluated levels. Conclusion: Dentistry students of third, fourth and fifth levels from Finis Terrae University had high level of empathy score. Women"s had the less changes and men"s had the more changes in the empathetic scores.