Economic evaluation of percutaneous cryoablation vs conventional surgery in extra-abdominal desmoid tumours in the Spanish healthcare system.

BACKGROUND: Desmoid tumours (DTs) or deep fibromatosis are benign soft-tissue tumours, sometimes locally aggressive, requiring intervention on some cases. Surgery has been the gold standard, but new less invasive techniques such as percutaneous cryoablation have proved their effectiveness, reducing health resources and complications. The study aimed to compare the total cost of percutaneous cryoablation and conventional surgery for patients with extra-abdominal and/or abdominal wall DTs, candidates for local ablative treatment in Spain. METHODS: A cost-analysis model was developed. An expert panel provided data about resource consumption for the percutaneous cryoablation technique and validated the epidemiology used for target population estimation. Unitary resources cost (€ 2022) derived from local cost databases. A retrospective analysis of 54 surgical cases in 3 Spanish hospitals was performed to estimate the cost of conventional surgery based on the cost of the Diagnosis-Related group (DRG) codes identified on this patient sample, weighted by each DRG proportion. The total cost for each alternative included intervention cost and complications cost, considering debridement required in 4.5% of cases with percutaneous cryoablation and minor surgery for surgical site infection in 18.0% for conventional surgery. RESULTS: The total cost for percutaneous cryoablation (€ 5774.78/patient-year) was lower than the total cost for conventional surgery (€ 6780.98/patient-year), yielding cost savings up to € 80,002 in 1 year for the entire cohort of 80 patients with DTs eligible for intervention estimated in Spain. One-way sensitivity analyses confirmed the results' robustness. CONCLUSION: Percutaneous cryoablation versus conventional surgery would yield cost savings for the management of DT patients in Spain. CRITICAL RELEVANCE STATEMENT: This manuscript provides insight into the economic impact derived from the savings related to the use of percutaneous cryoablation for desmoid-type tumours from the perspective of the Spanish National Healthcare System, providing useful information for the health decision-making process. KEY POINTS: • Desmoid tumours are locally aggressive and may require local therapy. • Percutaneous cryoablation procedure is less invasive than the conventional surgery. • Cost comparison shows savings associated to percutaneous cryoablation use.

Breast abscess due to Nannizziopsis obscura in an immunocompromised renal transplant patient after travel to Nigeria: case report and review.

BACKGROUND: Nannizziopsis is a genus of fungi with several known cases in reptiles of pyogranulomatous infections at cutaneous and musculoskeletal level, of rapid and fatal evolution. There are few cases of this genus described in humans, mainly skin affection but also with visceral abcesses, typically in immunosuppressed patients, with a recent visit to Africa. CASE PRESENTATION: A 45-year-old woman immunosuppressed after renal transplantation and with a recent visit to Nigeria presented with a painless breast abcess, ulceration to the skin and bleeding, and non hematic telorrhea. The mammogram, also completed with an ultrasound scan, showed a polylobulated nodule, BI-RADS 4C. Due to the suspicion of breast cancer, a core needle biopsy was performed and the pathology study showed abundant presence of fungal spores and hyphae. It was identified by genomic amplification of the internal transcription spacer region-2 and a percentage of similarity with sequences of Nannizziopsis obscura from GenBank of 98% was obtained. An empiric treatment with anidulafungin was initiated, and after the surgical resection, it was replaced by isavuconazole, with a total time of treatment of one month. CONCLUSIONS: This is the first case report of a successful treatment of Nannizziopsis obscura with isavuconazole, with the shortest time of treatment published for this fungi. We highlighted the importance of referring difficult to diagnose species to reference centers, as well as achieving the most complete resection in order to shorten the antibiotic therapy.

Vitamina D e hipertensión arterial / Vitamin D and hypertension

La deficiencia de vitamina D, definida como valores de 25-hidroxivitamina D < 20-30 ng/ml, es un problema prevalente en la población general. Además de relacionarse clásicamente con la enfermedad musculoesquelética, el déficit de vitamina D se ha relacionado con enfermedades autoinmunes, cáncer, enfermedades metabólicas y enfermedades cardiovasculares. La hipertensión arterial, como principal factor de riesgo cardiovascular, también se ha relacionado con el déficit de vitamina D, llevando a converger dos grandes problemas de salud prevalentes en la población mundial. Por tanto, este artículo revisa aquellos estudios más importantes que vinculan ambas patologías, los mecanismos descritos que las relacionan y la evidencia actual acerca del efecto que la suplementación de vitamina D podría tener sobre la hipertensión arterial (AU)

Low levels of vitamin D, defined as levels of 25-hydroxyvitamin D < 20-30 ng/ml, is a prevalent problem in the general population. Besides the classic relation with musculoskeletal disease, vitamin D has been also related to autoimmune diseases, cancer, metabolic diseases or cardiovascular diseases. High blood pressure, as the main cardiovascular risk factor, also has been related to vitamin D deficiency, constituting two prevalent worldwide health problems. Therefore, this article reviews the most important studies that combine both pathologies, the biological mechanism that relate them and the current evidence about the effect of vitamin D supplementation on hypertension (AU)

[Vitamin D and hypertension]. / Vitamina D e hipertensión arterial.

Low levels of vitamin D, defined as levels of 25-hydroxyvitamin D < 20-30 ng/ml, is a prevalent problem in the general population. Besides the classic relation with musculoskeletal disease, vitamin D has been also related to autoimmune diseases, cancer, metabolic diseases or cardiovascular diseases. High blood pressure, as the main cardiovascular risk factor, also has been related to vitamin D deficiency, constituting two prevalent worldwide health problems. Therefore, this article reviews the most important studies that combine both pathologies, the biological mechanism that relate them and the current evidence about the effect of vitamin D supplementation on hypertension.

DNA replication licensing affects cell proliferation or endoreplication in a cell type-specific manner.

In eukaryotic cells, the function of DNA replication licensing components (Cdc6 and Cdt1, among others) is crucial for cell proliferation and genome stability. However, little is known about their role in whole organisms and whether licensing control interfaces with differentiation and developmental programs. Here, we study Arabidopsis thaliana CDT1, its regulation, and the consequences of overriding licensing control. The availability of AtCDT1 is strictly regulated at two levels: (1) at the transcription level, by E2F and growth-arresting signals, and (2) posttranscriptionally, by CDK phosphorylation, a step that is required for its proteasome-mediated degradation. We also show that CDC6 and CDT1 are key targets for the coordination of cell proliferation, differentiation, and development. Indeed, altered CDT1 or CDC6 levels have cell type-specific effects in developing Arabidopsis plants: in leaf cells competent to divide, cell proliferation is stimulated, whereas in cells programmed to undergo differentiation-associated endoreplication rounds, extra endocycles are triggered. Thus, we propose that DNA replication licensing control is critical for the proper maintenance of proliferative potential, developmental programs, and morphogenetic patterns.

Evaluación de la implantación de una guía de incorporación de nuevos medicamentos en un hospital / Evaluation of a guide for the introduction of new drugs in a hospital

Objetivo: La incorporación de nuevos fármacos en los hospitales tiene una gran repercusión en el uso racional de medicamentos del Sistema Nacional de Salud, aunque existe un apreciable grado de variabilidad entre diferentes centros, lo que genera problemas de equidad y accesibilidad. Para dar respuesta a estos problemas, en Andalucía se elaboró la Guía de Incorporación de Nuevos Fármacos (GINF) que propone un procedimiento estructurado de toma de decisiones, fundamentado en la evaluación de la evidencia disponible. Material y métodos: Se evalúan todas las solicitudes recibidas en la Comisión de Farmacia y Terapéutica del Hospital Virgen del Rocío de Sevilla, con la metodología propuesta en la guía GINF, desde enero de 2002 a julio de 2003. Se realiza un estudio descriptivo sobre las características de los fármacos, los solicitantes, la actividad de la Comisión, indicadores de calidad de las solicitudes, el proceso seguido y las decisiones. Resultados: Se evaluó el total de las 32 solicitudes recibidas, correspondientes a 26 fármacos. Se aprobaron 19 (73 por ciento), aunque, de éstos, 14 lo fueron de forma restringida o con un protocolo específico de utilización, 4 como equivalentes terapéuticos y sólo 1 sin ninguna restricción. El 72 por ciento de los solicitantes aportó los ensayos clínicos pertinentes, mientras que las estimaciones sobre el número de pacientes/año y otros datos para la evaluación económica fueron mucho más escasas. Conclusiones: Es posible mejorar el proceso de introducción de fármacos en los hospitales mediante una guía que facilite a los profesionales y las comisiones de Farmacia criterios explícitos y transparentes (AU)