Contraceptive Counseling Strategies for Women Living With Human Immunodeficiency Virus: The Role of Integrating Reproductive Health and Human Immunodeficiency Virus Services to Prevent Perinatal Transmission in Colombia.

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of 2 contraceptive counseling strategies in Colombia for women living with human immunodeficiency virus (HIV). The first integrates (1) reproductive health and HIV services (integrated model [IM]), and the second (2) offers these services separately (non-IM). METHODS: Cost-effectiveness analysis from the third-party payer perspective (Colombian healthcare system). A decision analysis tree was used over a 24-month time horizon at a 3% discount rate, considering only direct costs. The outcome was the number of averted HIV perinatal transmission infections. We performed a discrete sensibility analysis and a probabilistic second-order sensitivity analysis with 10 000 iterations (Monte Carlo simulation). RESULTS: Compared with the non-IM, the IM prevented 3% additional HIV perinatal transmission infections, with an incremental cost-effectiveness of US dollar 525 and the highest net monetary benefit at the proposed willingness to pay. In the probabilistic sensitivity analysis, we found a substantial amount of parameter uncertainty that challenges the evidence in favor of the cost-effectiveness of the IM strategy. CONCLUSIONS: This study opens the possibility of integrating reproductive health and HIV services for women living with HIV in Colombia. In addition, it raises the necessity to produce additional good quality local empirical evidence to inform better and support the estimation of the economic efficiency of such a model in the country.

Searching Hit Potential Antimicrobials in Natural Compounds Space against Biofilm Formation.

Biofilms are communities of microorganisms that can colonize biotic and abiotic surfaces and thus play a significant role in the persistence of bacterial infection and resistance to antimicrobial. About 65% and 80% of microbial and chronic infections are associated with biofilm formation, respectively. The increase in infections by multi-resistant bacteria instigates the need for the discovery of novel natural-based drugs that act as inhibitory molecules. The inhibition of diguanylate cyclases (DGCs), the enzyme implicated in the synthesis of the second messenger, cyclic diguanylate (c-di-GMP), involved in the biofilm formation, represents a potential approach for preventing the biofilm development. It has been extensively studied using PleD protein as a model of DGC for in silico studies as virtual screening and as a model for in vitro studies in biofilms formation. This study aimed to search for natural products capable of inhibiting the Caulobacter crescentus enzyme PleD. For this purpose, 224,205 molecules from the natural products ZINC15 database, have been evaluated through molecular docking and molecular dynamic simulation. Our results suggest trans-Aconitic acid (TAA) as a possible starting point for hit-to-lead methodologies to obtain new inhibitors of the PleD protein and hence blocking the biofilm formation.

Nueva mutación identificada en el gen FOXP3 en lactante menor con diarrea crónica como manifestación de enteropatía autoinmune - síndrome IPEX / New mutation in FOXP3 gene identified in an infant with chronic diarrhea as manifestation of autoinmune enteropathy - IPEX syndrome

INTRODUCCIÓN: El síndrome IPEX (inmunodesregulación, poliendocrinopatía y enteropatía autoinmune ligada a X) causado por mutaciones en el gen FOXP3, se caracteriza por diarrea prolongada, alteraciones endocrinológicas y dermatitis. El tratamiento consiste en la administración de medicamentos inmunosupresores, siendo el trasplante de médula ósea la única cura potencial. OBJETIVO: Describir una nueva mutación del gen FOXP3, así como los hallazgos y evolución de un paciente con síndrome IPEX. CASO CLÍNICO: Lactante menor masculino que debutó al mes de vida con diarrea cró nica, falla intestinal e infecciones recurrentes. Exámenes de laboratorio y biopsia intestinal sugerentes de enteropatía autoinmune. Durante el seguimiento, el paciente presentó refractariedad al manejo inmunosupresor con esteroides, ciclosporina y tacrolimus, falleciendo a los 7 meses de edad por complicaciones vasculares. Antecedente familiar por línea materna de múltiples muertes en hombres menores de 1 año. Ante la sospecha de síndrome IPEX se realizó exoma en trío que reportó una mutación probablemente patogénica en el gen FOXP3. CONCLUSIÓN: Se documentó una nueva mutación del gen FOXP3 en paciente con síndrome IPEX. A pesar de la baja prevalencia de esta enfermedad, es importante el reconocimiento de síntomas no específicos pero sugerentes del diagnóstico.

INTRODUCTION: The IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syn drome is caused by the mutations of the FOXP3 gene, characterized by persistent diarrhea, endo crine disorders, and dermatitis. The treatment is the administration of immunosuppressive drugs, where hematopoietic stem cell transplantation is the only potential cure. OBJECTIVE: To describe a new FOXP3 gene mutation, as well as the findings and evolution of a patient with IPEX syndrome. CLINICAL CASE: Male infant presenting at one month of age with chronic diarrhea, intestinal failure, and recurrent infections. Lab tests and intestinal biopsy suggested autoimmune enteropathy. During follow-up, the patient presented resistance to immunosuppressive treatment with corticosteroids, cyclosporine, and tacrolimus, dying at 7 months of age due to vascular complications. He had a ma ternal family history of multiple deaths of men under 1 year of age. IPEX syndrome was suspected therefore a trio whole-exome sequencing was performed that showed a probably pathogenic FOXP3 gene mutation. CONCLUSION: A new FOXP3 gene mutation is reported in a patient with IPEX syndro me. Despite the low prevalence of this disease, it is important to recognize non-specific but suggestive symptoms for its diagnosis.

Immunodeficiency in a Patient with 22q11.2 Distal Deletion Syndrome and a p.Ala7dup Variant in the MAPK1 Gene.

The genetic basis for sporadic immunodeficiency in patients with 22q11.2 distal deletion syndrome is unknown. We report an adult with a type 1 (D-F) 22q11.2 distal deletion syndrome and recurrent severe infections due to herpes zoster virus, presenting mild T cell lymphopenia and diminished frequency of naive CD4+ T cells, but increased frequencies of central, effector, and terminally differentiated memory T cells. Antigen-specific CD4+ and CD8+ T cells to influenza, rotavirus, and SEB were conserved in the patient, but responses to tetanus toxoid were temporarily undetectable. Exomic sequencing identified the c.20_22dupCGG (NM_002745.4) variant in the remaining MAPK1 gene of the patient, which adds 1 alanine to the polyalanine amino-terminal tract of the protein (p.Ala7dup). The mother, unlike the father, was heterozygote for the variant. Western blot analysis with the patient's activated PBMCs showed a 91% reduction in the MAPK1 protein. Further studies will be necessary to determine whether or not the variant present in the remaining MAPK1 gene of the patient is pathogenic.

Interaction with Soil Bacteria Affects the Growth and Amino Acid Content of Piriformospora indica.

Exploration of the effect of soil bacteria on growth and metabolism of beneficial root endophytic fungi is relevant to promote favorable associations between microorganisms of the plant rhizosphere. Hence, the interaction between the plant-growth-promoting fungus Piriformospora indica and different soil bacteria was investigated. The parameters studied were fungal growth and its amino acid composition during the interaction. Fungus and bacteria were confronted in dual cultures in Petri dishes, either through agar or separated by a Perspex wall that only allowed the bacterial volatiles to be effective. Fungal growth was stimulated by Azotobacter chroococcum, whereas Streptomyces anulatus AcH 1003 inhibited it and Streptomyces sp. Nov AcH 505 had no effect. To analyze amino acid concentration data, targeted metabolomics was implemented under supervised analysis according to fungal-bacteria interaction and time. Orthogonal partial least squares-discriminant analysis (OPLS-DA) model clearly discriminated P. indica-A. chroococcum and P. indica-S. anulatus interactions, according to the respective score plot in comparison to the control. The most observable responses were in the glutamine and alanine size groups: While Streptomyces AcH 1003 increased the amount of glutamine, A. chroococcum decreased it. The fungal growth and the increase of alanine content might be associated with the assimilation of nitrogen in the presence of glucose as a carbon source. The N-fixing bacterium A. chroococcum should stimulate fungal amino acid metabolism via glutamine synthetase-glutamate synthase (GS-GOGAT). The data pointed to a stimulated glycolytic activity in the fungus observed by the accumulation of alanine, possibly via alanine aminotransferase. The responses toward the growth-inhibiting Streptomyces AcH 1003 suggest an (oxidative) stress response of the fungus.

[New mutation in FOXP3 gene identified in an infant with chronic diarrhea as manifestation of autoinmune enteropathy - IPEX syndrome]. / Nueva mutación identificada en el gen FOXP3 en lactante menor con diarrea crónica como manifestación de enteropatía autoinmune - Síndrome IPEX.

INTRODUCTION: The IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syn drome is caused by the mutations of the FOXP3 gene, characterized by persistent diarrhea, endo crine disorders, and dermatitis. The treatment is the administration of immunosuppressive drugs, where hematopoietic stem cell transplantation is the only potential cure. OBJECTIVE: To describe a new FOXP3 gene mutation, as well as the findings and evolution of a patient with IPEX syndrome. CLINICAL CASE: Male infant presenting at one month of age with chronic diarrhea, intestinal failure, and recurrent infections. Lab tests and intestinal biopsy suggested autoimmune enteropathy. During follow-up, the patient presented resistance to immunosuppressive treatment with corticosteroids, cyclosporine, and tacrolimus, dying at 7 months of age due to vascular complications. He had a ma ternal family history of multiple deaths of men under 1 year of age. IPEX syndrome was suspected therefore a trio whole-exome sequencing was performed that showed a probably pathogenic FOXP3 gene mutation. CONCLUSION: A new FOXP3 gene mutation is reported in a patient with IPEX syndro me. Despite the low prevalence of this disease, it is important to recognize non-specific but suggestive symptoms for its diagnosis.

Identifying the factors for improving quality of oral fluorescein angiography.

AIM: To evaluate the quality of oral fluorescein angiography (FA) in relation to food intake. METHODS: This is an observational, case-crossover study. We collected information from patients undergoing routine oral FA for retinal disease at the Shiley Eye Institute. Eighty patients (160 eyes) were analysed. Fasting and non-fasting images of the same patient were recorded, compared and analysed for different image quality parameters and clinical relevance by experienced retina specialists. RESULTS: When analysing the images, intergrader agreement was moderate to good with a Kappa averaging 0.60 (0.5-0.85). When patients were fasting pre-imaging, better angiography quality scores were achieved when compared with images taken when patients were non-fasting (mean 0.84 vs 0.72, p<0.001). Multivariate analysis showed that non-fasting patients with higher body mass index had the worst scores. Other clinical parameters, such as staining of drusen, staining of disciform scars or central and peripapillary atrophy, were also significantly better during the pre-fasting exam (p<0.001). Oral FA was approximately 22% faster (time to fluorescein dye appearance) under fasting conditions than non-fasting (mean±SD, minutes, 18.7±6.9 vs 25.14±8.1, p<0.001). CONCLUSION: Fasting oral FA provided significantly better quality images as well as faster optimal imaging times when compared with non-fasting oral FA. By improving its overall quality, oral FA could be a useful adjunctive examination to optical coherence tomography (OCT) and OCT angiography in patients who require FA studies but who have difficult access or refuse an invasive procedure.

Neutral lipid storage disease with myopathy and dropped head syndrome. Report of a new variant susceptible of treatment with late diagnosis.

Neutral lipid storage disease with myopathy (NLSDM) is characterized by the accumulation of cytoplasmic triglyceride droplets in various tissues; this very rare condition is caused by mutations in the PNPLA2 gene, susceptible to specific pharmacological management that decreases clinical progression. We describe the clinical and biochemical characteristics of a Colombian patient with a previously unreported homozygous mutation in the PNPLA2 gene with a difficult to manage disease, who was diagnosed late by advances in molecular techniques.

The assessment of pharmacoeconomic studies quality of Levodopa's use for the management of Parkinson's diseases, 2010-2015 / Evaluación de la calidad de estudios farmacoeconómicos del uso de Levodopa para el manejo de la enfermedad de Parkinson, 2010-2015

SUMMARY Levodopa (LD) has been the first choice in the management of Parkinson's disease (PD), since its introduction in the drug market; however, its prolonged use is related to the occurrence of motor complications, affecting the functionality and quality of life. Parkinson's disease is one of the most frequent among the neurodegenerative diseases in the world, and it is expected that the number of people who suffer it, will increase due to global population aging. The PD represents, nowadays and for the future, a high economic burden from all perspectives, including patients, payers, and society. So it is necessary to know about the use of LD in its treatment and to realize the quality of pharmacoeconomic studies in the past five years, to identify reliable sources of information related to the costs and benefits of this medication to contribute in making decisions. The aim of this paper is to assess the methodological quality of pharmacoeconomic studies related to the use of LD in PD, specifically those that are identified as cost-utility studies, applying the QHES instrument. A total of19 articles were found, of which 5 met the inclusion criteria and were subjected to examination. The average overall score obtained after the evaluation was 77.2 out of 100, making evident a good quality of studies according to the method used.

RESUMEN La Levodopa (LD) ha sido desde su introducción en el mercado la primera elección en el manejo de la enfermedad de Parkinson (EP); sin embargo, su uso prolongado está relacionado con la aparición de complicaciones motoras, afectándose la funcionalidad y calidad de vida. La EP es una de las enfermedades neurodegenerativas que se presenta con mayor frecuencia en el mundo y se espera que el número de personas que la padecen aumente, debido al envejecimiento poblacional a nivel mundial. La EP representa, actualmente y a futuro, una alta carga económica desde todas las perspectivas, incluyendo: pacientes, pagadores y la sociedad; por lo cual es necesario conocer el uso de la LD en el tratamiento de la misma y lograr determinar la calidad de los estudios farmacoeconómicos realizados en los últimos cinco años, para identificar fuentes fiables de información relacionadas con los costos y los beneficios de este medicamento que aporten en la toma de decisiones. El objetivo de este artículo es evaluar la calidad metodológica de los estudios farmacoeconómicos relacionados con el uso de la LD en la EP, específicamente aquellos que se cataloguen como estudios de costo-utilidad, aplicando el instrumento QHES. Se encontraron en total 19 artículos, de los cuales cinco cumplieron los criterios de inclusión y fueron sometidos al respectivo análisis. El puntaje global promedio obtenido posterior a la evaluación fue de 77,2 sobre 100, haciendo evidente una buena calidad de los estudios de acuerdo con el método utilizado.

Transient evoked oto-acoustic emission screening in newborns in Bogotá, Colombia: a retrospective study.

OBJECTIVE: The aim of this study was to investigate the characteristics and performance of transient evoked oto-acoustic emission (TEOAE) hearing screening in newborns in Colombia, and analyze all possible variables and factors affecting the results. MATERIALS AND METHODS: An observational, descriptive and retrospective study with bivariate analysis was performed. The study population consisted of 56,822 newborns evaluated at the private institution, PREGEN. TEOAE testing was carried out as a pediatric hearing screening test from December 2003 to March 2012. The database from PREGEN was revised, and the protocol for evaluation included the same screening test performed twice. Demographic characteristics were recorded and the newborn's background was evaluated. Basic statistics of the qualitative and quantitative variables, and statistical analysis were obtained using the chi-square test. RESULTS: Of the 56,822 records examined, 0.28% were classed as abnormal, which corresponded to a prevalence of 1 in 350. In the screened newborns, 0.08% had a major abnormality or other clinical condition diagnosed, and 0.29% reported a family history of hearing loss. A prevalence of 6.7 in 10,000 was obtained for microtia, which is similar to the 6.4 in 10,000 previously reported in Colombia (database of the Latin-American Collaborative Study of Congenital Malformations - ECLAMC). Statistical analysis demonstrated an association between presenting with a major anomaly and a higher frequency of abnormal results on both TEOAE tests. CONCLUSIONS: Newborns in Colombia do not currently undergo screening for the early detection of hearing impairment. The results from this study suggest TEOAE screening tests, when performed twice, are able to detect hearing abnormalities in newborns. This highlights the need to improve the long-term evaluation and monitoring of patients in Colombia through diagnostic tests, and to provide tests that are both sensitive and specific. Furthermore, the use of TEOAE screening is justified by the favorable cost: benefit ratio demonstrated in many countries worldwide.

Evaluación de la calidad de estudios farmacoeconómicos del uso de los inhibidores de la bomba de protones en enfermedad ácido péptica / Quality assessment of pharmacoeconomic studies of the use of proton pump inhibitors in peptic ulcer disease

Los inhibidores de la bomba de protones (IBP) son un grupo de fármacos que reducen la secreción de ácido en el estómago, por lo que son ampliamente utilizados en el tratamiento de la úlcera péptica. La notable prevalencia e incidencia de esta patología sugiere que los recursos económicos y humanos dedicados a su tratamiento son considerables y, por tanto, es necesario identificar fuentes fiables de información relacionadas con los costos y los beneficios de estos agentes terapéuticos que permitan valorarlos en términos de eficiencia para mejorar su prescripción racional. Este trabajo realizó una revisión de los estudios farmacoeconómicos correspondientes al uso de los ibp en la prevención y tratamiento de la enfermedad ácido péptica y se presenta una evaluación pareada de la calidad metodológica de la bibliografía basada en el instrumento qhes (Ofman et al., [10]). De los diez artículos revisados, cuatro son de costo-efectividad, dos de costo-utilidad, tres de descripción de costos y uno de minimización de costos. El puntaje global promedio obtenido por los estudios evaluados fue de 66,6 sobre 100. Cuatro de ellos puntuaron por debajo de 60, haciendo evidente deficiencias en la calidad de los estudios de acuerdo con el instrumento usado, además pone de manifiesto que se necesitan evaluaciones farmacoeconómicas en relación con el uso de los ibp para la prevención y el tratamiento de la úlcera péptica, especialmente estudios de costo-efectividad, que cumplan con los estándares de calidad metodológica.

Proton pump inhibitors (PPI) are a group of drugs that reduce gastric acid secretion and therefore are widely used in the treatment of peptic ulcer. The remarkable prevalence and incidence of this disease suggests that economic and human resources devoted to treatment are considerable and therefore it is necessary to identify reliable sources of information related to the costs and benefits of these therapeutic agents to appraise in terms of efficiency to improve rational prescribing. This paper conducted a review of pharmacoeconomic studies pertaining to the use of ppi in the prevention and treatment of peptic acid disease, as it presents a paired assessment of methodological quality of the literature instrument based on qhes (Ofman et al., [10]). Of the ten articles reviewed, four were cost-effectiveness, two cost-utility, three description of cost, and one of cost minimization. The average overall scored 66.6 out of 100. Four of them scored below 60.0, making it a clear need for pharmacoeconomic evaluations in connection with the use of ppi for prevention and treatment of peptic ulcer, especially cost-effectiveness studies that meet standards of methodological quality.

Estudio de costo-efectividad del programa de vacunación contra Brucella abortus en bovinos en el departamento de Nariño / Cost-effectiveness analysis of the vaccination program against bovine Brucella abortus in the Department of Nariño.

Objetivo. Determinar la eficiencia del programa de vacunación en bovinos contra Brucella abortus en el departamento de Nariño, desde la perspectiva de la Sociedad de Agricultores y Ganaderos de Nariño (Sagán). Materiales y métodos. Se realizó un estudio costo-efectividad empleando un modelo determinístico, el horizonte de tiempo fue desde la vacunación de los animales hasta que inician producción (24 meses). Se construyó un modelo de la historia natural de la enfermedad basado en revisión de literatura; los costos se establecieron desde la perspectiva de Sagán en el año 2008, se utilizó la menor efectividad de la vacuna reportada en la literatura y el escenario más conservador de la enfermedad mediante un análisis de sensibilidad en las principales variables. Resultados. Se encontró que la vacuna cepa 19 en una cohorte hipotética de 100.000 animales y con una prevalencia de la enfermedad de 8,6% permite un ahorro de $1.302.670.935. Al analizar la razón costo-efectividad incremental se observa que en las diferentes variables el programa de vacunación es dominante y se produce una relación costo-efectividad favorable en los diversos resultados en salud analizados. Conclusiones. El programa de control y erradicación de brucelosis en el departamento de Nariño con vacuna cepa 19 es eficiente desde la perspectiva de Sagán.

Objective: A cost-effectiveness analysis was conducted for the control and eradication program of bovine Brucellosis using the vaccine against strain 19 in the Department of Nariño (Colombia). Materials and methods: A cost-effectiveness study was conducted using a deterministic model with a hypothetic cohort of 100.000 animals, the time horizon was from the time of vaccination until the animals go into production (24 months). A model of the natural history of disease was constructed with data extracted from literature review, the costs were established from the perspective of SAGAN in 2008, the lowest effectiveness figure for the vaccine was used with a conservative illness scenario, and a sensitivity analysis was performed for the prevalence variables, milk price, and the cost and coverage of the vaccine. Results: A favorable cost-effectiveness relation for the different health outcomes analyzed within this work (Abortions, temporal infertility, mortality, prenatal mortality, milk and meat Production) was found. Conclusions: The Brucellosis control and eradication program in the Department Nariño against strain 19 is efficient from SAGAN´s perspective; this program should count with support on the part of relevant institutions for the epidemiologic vigilance of this disease.

Análisis de costos de psicofármacos en la consulta psiquiátrica de un servicio médico estudiantil universitario / Costs analysis of psychotherapeutic drugs in an university students health service

Objetivo: establecer los costos de los medicamentos prescritos y su impacto en el presupuesto familiar, en la consulta de psiquiatría del servicio médico estudiantil de la sede Bogotá de la Universidad Nacional de Colombia. Metodología: estudio observacional, transversal y análisis de costos de los medicamentos prescritos a los estudiantes que asistieron a la consulta especializada de psiquiatría del servicio médico estudiantil de la sede Bogotá de la Universidad durante el 2006. Se incluyeron 191 historias clínicas. Resultados: el 81% de los estudiantes eran menores de 25 años, 95% solteros, la mayoría pertenecía a las Facultades de Medicina y Ciencias Humanas. Los diagnósticos más frecuentes fueron del espectro depresivo y ansioso y los medicamentos más usados los antidepresivos, especialmente ISRS, y ansiolíticos. Se encontraron diferencias marcadas entre el costo de los psicofármacos de marca y el genérico más barato, que llegó en algunos casos a ser 50 veces mayor. El costo promedio de las prescripciones/mes fue de $ 72.773 (5,4 SMDL) si se usaban sólo medicamentos genéricos y de $ 367.160 (27 SMDL) si se empleaban sólo medicamentos de marca. En promedio, las familias debían dedicar el 8% y el 45,6% de su presupuesto familiar para comprar los medicamentos genéricos o de marca, respectivamente. No hubo diferencias en el costo promedio del tratamiento en SMDL para los trastornos del espectro depresivo. Conclusiones: de acuerdo con la revisión de la literatura, es la primera vez que se hace una evaluación de costos de psicofármacos en una consulta especializada de un servicio médico estudiantil. El factor económico puede ser una limitante en el acceso a los psicofármacos en esta consulta especializada, lo cual puede implicar, en la práctica, no tomar los medicamentos prescritos. Por tanto, es importante tener en cuenta este aspecto al momento de la prescripción y buscar alternativas para facilitar el acceso a los medicamentos.

Objective: To assess drug prescription costs and their economic impact on family budgets, in the psychiatry consultation at the student health service of the Colombian National University in Bogota. Methods: Observational, descriptive, cross- sectional, retrospective study of prescription drug costs to students who attended psychiatry service during 2006. One- hundred- ninety- one medical files were included. Results: A total of 81% of students were under 25 years, 95% single, most of them medicine and basic sciences students. The most common diagnoses were depression and anxious spectrum which were treated with antidepressants, especially SSRI (selective serotonin re uptake inhibitors), and anxiolytics. The average cost of prescriptions per month was $ 72,773 (5.4 LDMW- legal daily minimum wage) using only generic drugs and $ 367,160 (27 LDMW) if brand name drugs were only used, that would mean increasing the drugs by spending in some cases 50 times higher. On average, families spent 8.8% and 45.6% of their household budget to buy generic or branded, respectively. There was no difference in the average cost of treatment in LDMW for depressive spectrum disorders. Conclusions: The economic aspect may be a limiting factor in access to specialized psychiatric drugs that may affect the beginning and compliance of treatments. Therefore it is important to facilitate access to medicines through generic and therapeutic substitution policies.

Interpretación de estudios de costo-efectividad en ginecología / Interpreting cost-effectiveness analysis studies in gynecology

Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios. Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes...

Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios. Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes...

Intervención educativa sobre prescripción de AINES en un hospital de baja complejidad / Educational program on prescription of nsaids in a low-complexity hospital

Se analizó el efecto de dos intervenciones educativas en intervalos de seis meses sobre el uso de aines (grupo M01 según ATC de 2008), medido en términos de costos totales y dosis diarias definidas (ddd)/consultas de urgencias y ambulatorias, entre enero de 2007 y junio de 2008 en el hospital San Antonio del municipio de Marmato (Caldas) en el centro de Colombia. El costo total del grupo M01 disminuyó el 69,3% a diciembre de 2007 y 65,1% en junio de 2008. En ddd/consultas de urgencias y ambulatorias, el descenso fue en el primer semestre del 40,7% y en el segundo semestre del 48,5%. Naproxeno 250 mg e ibuprofeno 400 mg tabletas y diclofenaco 75 mg ampolla disminuyeron en consumos el 74,1%, 38,9% y 78,7%, respectivamente; mientras que diclofenaco 50 mg tableta incrementó el 280,0%. La sustitución en el perfil de uso de diclofenaco oral en lugar de naproxeno oral, y la disminución del uso de diclofenaco inyectable, contribuyó a la disminución del costo total. Los resultados positivos se obtuvieron por la participación y actitud favorable de todos los médicos generales del hospital hacia las reuniones de educación basadas en evidencias.

Two educational interventions were analyzed at intervals of six months on the use of nsaids (group M01 as atc, 2008) measured in terms of total costs and Defined Daily Dose (ddd)/Ambulatory and emergency visits between January 2007 and June 2008 at the San Antonio hospital of Marmato (Caldas) in the center of Colombia. The total cost of the M01 group decreased 69.3% in December 2007 and 65.1% in June 2008. The decline of ddd/emergency and ambulatory consultations was of 40.7% in the first semester, and 48.5% in the second semester. Consumptions of naproxen 250 mg and ibuprofen 400 mg tablets, and diclofenac 75 mg ampoules decreased 74.1%, 38.9%, and 78.7% respectively, while diclofenac 50 mg tablet increased 280.0%. Oral diclofenac substitution instead of oral naproxen, and decreased use of diclofenac injectable, contributed to low total cost. Positive results were obtained by the participation and positive attitude of hospital general physicians to the educational evidence-based meetings.

Olga María Rivero González: paradigma de la enfermería cubana / Olga María Rivero González: paradigm of Cuban nursing

Se realizó una nota biográfica de la destacada profesora Olga María Rivero González. Utilizamos como método teórico en este material el método histórico-lógico, para el ordenamiento cronológico de sus datos biográficos, así como el análisis y la síntesis. Como método empírico se utilizó la revisión documental, entrevistas a otros profesionales y a la profesora para poder resumir los aspectos más importantes de su vida personal y profesional. Se destaca su ejemplo como patrón a seguir por los estudiantes y graduados, con el propósito de estimular la vocación y la identidad profesional de las actuales y futuras generaciones de la enfermería, se revela su firmeza ética y liderazgo, sus valores y cualidades que la distinguen. Además, se subraya su papel protagónico en la formación de las nuevas generaciones, sus dotes de dirigente administrativa en los servicios asistenciales y docentes de la profesión(AU)

A biographical note on the outstanding professor Olga María Rivero González was made. The historical-logical method was used in this paper as a theoretical system for the chronological arrangement of her biographical data. The analysis and synthesis were also applied. The documentary review, the interviews to other professionals and to the professor were used as an empirical method in order to summarize the most important aspects of her personal and professional life. Her example as a pattern to be followed by students and graduates to stimulate the vocation and the professional identity of the present and future nursing generations is stressed, and her ethical firmness, leadership, values and qualities are revealed. Her protagonist role in the formation of new generations and her managerial abilities in the health care and teaching services are also emphasized(AU)