ABSTRACT
Respiratory syncytial virus (RSV) is the agent that causes more hospitalizations and deaths due to lower acute respiratory infection. Its distribution is widespread, and almost every child has been infected by the age of two years. Different risk populations have been identified: preterm newborns (NB), children with congenital heart disease, bronchopulmonary dysplasia, Down syndrome, cystic fibrosis, asthmatics, neuromuscular diseases, among others. However, preterm NBs, children with congenital heart disease or bronchopulmonary dysplasia show higher rates of hospitalization and death from RSV. In the late 90s, monoclonal antibodies against RSV were developed, with demonstrated efficacy and safety for the prevention of RSV hospitalizations in these populations. Currently, the American Academy of Pediatrics recommends this therapy for the prevention of severe infection in the population at higher risk. Economic evaluations have been conducted to determine the effectiveness of immunization, resulting favorable for palivizumab. Immunization in Mexico has resulted cost-effective in NBs under 32 gestation weeks. Mexican authorities should discuss the inclusion of palivizumab in their clinical guidelines.
El virus sincicial respiratorio (VSR) es el agente que ocasiona más hospitalizaciones y muertes por infección aguda de vías respiratorias bajas. La mayoría de los niños ya han sido infectados a los 2 años de edad. Se han identificado diferentes poblaciones de riesgo: recién nacidos pretérmino y niños con cardiopatía congénita, displasia broncopulmonar, síndrome de Down, fibrosis quística, asma y enfermedades neuromusculares, entre otras. Sin embargo, las tasas de hospitalización y de muerte por VSR son más altas en los recién nacidos pretérmino y en los niños con cardiopatía congénita o displasia broncopulmonar. A finales de los años 90 se desarrollaron anticuerpos monoclonales contra el VSR, los cuales demostraron ser eficaces y seguros en la prevención de hospitalizaciones por VSR en estas poblaciones. Actualmente, la American Academy of Pediatrics los recomienda para la prevención de la infección grave en la población de mayor riesgo. Se ha recurrido a evaluaciones económicas para determinar la efectividad de la inmunización, las cuales han sido favorables para el palivizumab. En México se ha demostrado que la inmunización es costo-efectiva en los recién nacidos menores de 32 semanas de gestación. Las autoridades mexicanas deben discutir la inclusión del palivizumab en sus guías de práctica clínica.
Subject(s)
Pediatrics , Respiratory Syncytial Virus Infections , Antibodies, Monoclonal, Humanized , Antiviral Agents , Child , Child, Preschool , Humans , Infant, Newborn , Mexico/epidemiology , Respiratory Syncytial Virus Infections/drug therapy , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/prevention & control , United StatesABSTRACT
Cystic fibrosis (CF) is the most common recessive genetic disease in the Caucasian population. Unanimously, all CF care guidelines in developed countries require that management be provided by a network of specialized CF care centers that cover the entire population of patients, pediatric and adult. The establishment of such centers of excellence requires a level of experience that is achieved only by the conformation of a multidisciplinary team of trained and experienced health professionals, caring for a sufficient number (critical mass) of patients to achieve the best clinical outcomes and survival rates at a lower cost which is achieved by distributing health resources to this small network of centers of excellence. The experience of the health team of the Hospital San Borja Arriaran participating in the project promoted by the COA/UAB CF Center in Birmingham, Alabama in the United States shows that it is possible to transfer knowledge and quality management know-how, creating a cutting-edge, world-class, CF Center which performs a multidisciplinary care management of high quality, that is finally reflected in significant improvements in nutritional parameters and lung function of the patients.
La fibrosis quística (FQ) es la enfermedad genética recesiva más común en la población caucásica. De manera unánime todas las normativas de cuidado de FQ de países desarrollados requieren que el manejo sea dado por una red de centros especializados de cuidado en FQ que cubra toda la población de pacientes, pediátricos y adultos. El establecimiento de dichos centros de excelencia requiere de un nivel de experiencia que se logra solo por la constitución de un equipo multidisciplinario entrenado y experimentado de profesionales de la salud, a cargo de un número suficiente (masa crítica) de pacientes para lograr los mejores resultados de sobrevida, a un costo menor, lo cual se logra al distribuir los recursos de salud a un número reducido de centros de excelencia. La experiencia del equipo de salud del Hospital San Borja Arriarán en el proyecto impulsado por el COA/UAB CF Center de Birmingham, Alabama de Estados Unidos, demuestra que es posible la transferencia de conocimientos y de gestión de calidad, formando un Centro FQ de vanguardia y de categoría mundial, que realiza un manejo multidisciplinario de primera calidad, reflejado en la mejoría nutricional y de función pulmonar.
Subject(s)
Humans , Cystic Fibrosis/therapy , Patient Care Team , Delivery of Health Care/organization & administration , Survival AnalysisABSTRACT
PURPOSE OF REVIEW: Cystic fibrosis (CF) has been underdiagnosed and undertreated for many years in Latin American countries, including Chile. This article describes the evolution of CF care in view of recent reforms in healthcare delivery in Chile, and the opportunities that exist to improve outcomes. RECENT FINDINGS: The characteristics of the population of CF patients are described using recently collected data. Unfortunately, current data do not allow an accurate assessment of CF care in Chile. The situation is similar elsewhere in Latin America. Further, we describe the obstacles to achieving optimum CF care, among them lack of expertise among healthcare professionals, dispersion of patients between private and public health systems, and limited laboratory infrastructure despite significant economic growth and improvement in national health indices. We discuss different avenues to enhance CF care in Chile and Latin America. SUMMARY: Centralization and organization of CF care within centers of excellence employing 'best practices' and engaging in quality-improvement initiatives, and the creation of national data registries represent important steps to improve survival, diminish morbidity, and allow more extensive participation of Latin American CF patients in multicenter clinical research.