Glucose-6-phosphate dehydrogenase deficiency and the use of primaquine: top-down and bottom-up estimation of professional costs / Deficiência de glicose-6-fosfato desidrogenase e uso de primaquina: estimativa de custos de profissionais por macrocusteio e microcusteio

ABSTRACT The aim of this study has been to study whether the top-down method, based on the average value identified in the Brazilian Hospitalization System (SIH/SUS), is a good estimator of the cost of health professionals per patient, using the bottom-up method for comparison. The study has been developed from the context of hospital care offered to the patient carrier of glucose-6-phosphate dehydrogenase (G6PD) deficiency with severe adverse effect because of the use of primaquine, in the Brazilian Amazon. The top-down method based on the spending with SIH/SUS professional services, as a proxy for this cost, corresponded to R$60.71, and the bottom-up, based on the salaries of the physician (R$30.43), nurse (R$16.33), and nursing technician (R$5.93), estimated a total cost of R$52.68. The difference was only R$8.03, which shows that the amounts paid by the Hospital Inpatient Authorization (AIH) are estimates close to those obtained by the bottom-up technique for the professionals directly involved in the care.

RESUMO A pesquisa teve por objetivo estudar se o macrocusteio, baseado no valor médio identificado no Sistema de Internação Hospitalar (SIH/SUS), constitui um bom estimador do custo de profissionais de saúde por paciente, tendo como comparação o método de microcusteio. O estudo foi desenvolvido no contexto da assistência hospitalar oferecida ao portador da deficiência de glicose-6-fosfato desidrogenase (dG6PD) do sexo masculino com evento adverso grave devido ao uso da primaquina, na Amazônia Brasileira. O macrocusteio baseado no gasto em serviços profissionais do SIH/SUS, como proxy desse custo, correspondeu a R$60,71, e o microcusteio, baseado nos salários do médico (R$30,43), do enfermeiro (R$16,33) e do técnico de enfermagem (R$5,93), estimou um custo total de R$52,68. A diferença foi de apenas R$8,03, mostrando que os valores pagos pela Autorização de Internação Hospitalar (AIH) são estimadores próximos daqueles obtidos por técnica de microcusteio para os profissionais envolvidos diretamente no cuidado.

Association of severe malaria with ABO-blood group types in an endemic zone of Colombia / Asociación de malaria severa con tipo de grupo sanguíneo ABO en una zona endémica de Colombia

Introduction: malaria is considered one of the most important tropical illnesses in public health causing millions of infections and deaths each year. Many studies have tried to establish an association between the severe form of the disease and the ABO-blood group type. In Colombia, a country with large endemic zones for malaria there are not enough studies or statistic data about this possible association. Methods: a retrospective case-control study of patients with severe and uncomplicated malaria in the endemic zone of Apartadó, Colombia, was performed between January 2000 and June 2006. Only the clinical records with blood group ABO and Rh classification were included. Results: a total sample of 92 patients was obtained: 49 with severe malaria and 43 with uncomplicated malaria. From the total sample, 68.5% were women and the median age of 21.5 years (min 1-max 80). Of the patients with diagnosis of severe malaria, 59.2% were women. The more frequent parasite species was Plasmodium falciparum. Severe malaria was more frequent among patients classified with blood group O (65.3%) and positive Rh (93.9%), but this association was not statistically significant. Conclusion: even though severe malaria was more frequent among patients classified with blood group O and positive Rh, an association between blood group and severe malaria could not be established. The controversial association of these variables previously found in other populations could be probably explained by the demographic distribution and characteristics of those.

Introducción: la malaria es considerada una de las más importantes enfermedades tropicales en salud pública, causando millones de infecciones y muertes cada año. Muchos estudios han tratado de establecer una asociación entre la forma grave de la enfermedad y la clasificación sanguínea ABO. En Colombia, un país con grandes zonas endémicas de malaria, no existen suficientes estudios y datos estadísticos acerca de esta posible asociación. Métodos: se realizó un estudio de casos y controles de pacientes con malaria severa y no complicada en la zona endémica de Apartadó, Colombia y ejecutado entre enero de 2000 y junio de 2006. Sólo las historias clínicas con información acerca de la clasificación sanguínea ABO o Rh fueron incluidas. Resultados: la muestra total fue de 92 pacientes, 49 con malaria grave y 43 con malaria no complicada. De la muestra total, 68,5% eran mujeres y la edad media de 21,5 años (mínimo1-máximo 80). De los pacientes con diagnóstico de malaria grave, 59,2 % eran mujeres. El parásito más frecuente fue la especie de P. falciparum. La malaria grave fue mas frecuente entre los pacientes clasificados con grupo sanguíneo O (65,3%) y Rh positivo (93,9%), pero esta asociación no fue estadísticamente significativa. Conclusión: aunque la malaria severa fue mas frecuente en pacientes con grupo sanguíneo O y Rh positivo, una asociación entre la severidad de la malaria y la clasificación sanguínea no pudo ser establecida. La controvertida asociación entre estas variables previamente encontrada en otras poblaciones, probablemente puede ser explicada por la distribución y características demográficas de dichas poblaciones.