Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil.

AIMS: The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil. METHODS: A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results. RESULTS: The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses. CONCLUSIONS: This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.

Imagen de tractografía 3T: anatomía y aplicaciones clínicas / 3T tractography imaging: anatomy and clinical applications

La tractografía (TG) es la única técnica no invasiva que permite la disección in vivo de las fibras de la sustancia blanca. Esta técnica puede estudiar las fibras de proyección, de asociación y las fibras comisurales, y supone una mejora y un importante complemento a la imagen de la resonancia magnética convencional. La TG es una herramienta clave para la realización de mapeos subcorticales preoperatorios y existe una buena correlación entre la TG y la técnica de estimulación directa subcortical. La TG puede presentar falsos negativos en aquellas regiones infiltradas por el tumor o con efecto de masa. Además, una TG negativa no excluye la persistencia de fibras funcionales. La TG es capaz de mostrar alteraciones en otras afecciones (malformaciones congénitas, afección isquémica y enfermedades desmielinizantes) (AU)

Tractography (TG) is the only non-invasive technique that enables the fibres of the white substance to be dissected. This technique can study the projection, association, and commissural fibres, and is an improvement and an important complement to conventional MR imaging. TG is an important tool for preoperative sub-cortical mapping, and there is a good correlation between TG and the direct sub-cortical stimulation technique. TG can have false positives in regions infiltrated by the tumour or with a mass effect. Furthermore, a negative TG does not exclude functional fibre persistence. TG is capable of demonstrating changes in other pathologies (congenital malformations, ischaemic disease and demyelinating diseases) (AU)

[3T tractography imaging: anatomy and clinical applications]. / Imagen de tractografía 3T: anatomía y aplicaciones clínicas.

Tractography (TG) is the only non-invasive technique that enables the fibres of the white substance to be dissected. This technique can study the projection, association, and commissural fibres, and is an improvement and an important complement to conventional MR imaging. TG is an important tool for preoperative sub-cortical mapping, and there is a good correlation between TG and the direct sub-cortical stimulation technique. TG can have false positives in regions infiltrated by the tumour or with a mass effect. Furthermore, a negative TG does not exclude functional fibre persistence. TG is capable of demonstrating changes in other pathologies (congenital malformations, ischaemic disease and demyelinating diseases).

Aumento de tamaño muscular secundario a metástasis de adenocarcinoma gástrico no conocido / Increase in muscle mass secondary to metastasis of an unknown gastric adenocarcinoma

Objetivo. Presentar un caso de manifestación atípica de metástasis en forma de múltiples masas musculares. Caso clínico. Varón de 52 años con úlcera gástrica como único antecedente de interés que acudió al servicio de traumatología por dolor con la deambulación en el glúteo izquierdo de intensidad progresiva y con efecto de masa asociado. Resultados. Las pruebas de imagen realizadas detectaron múltiples masas musculares. La biopsia de las mismas dio como resultado metástasis de adenocarcinoma gástrico en anillo de sello. Conclusión. La presentación insidiosa de sintomatología muscular, en ausencia de antecedente traumático, debe hacer sospechar y valorar la posibilidad de patología tumoral (AU)

Objective. To present a case of rare manifestation of metastases as multiple muscular masses. Clinical case. A 52 year old male with gastric ulcer as the only history of interest went to traumatology service referring to progressive pain in the left buttock with associated mass effect when walking. Results. Imaging tests detected a multiple muscle mass. The biopsies showed signet ring gastric adenocarcinoma metastases. Conclusion. The insidious presentation of muscular symptoms in the absence of traumatic injury, should be suspected and the possibility of a tumour assessed (AU)