Cost-Effectiveness of rFVIIa versus pd-aPCC in the Management of Mild to Moderate Bleeds in Pediatric Patients with Hemophilia A with Inhibitors in Mexico.

OBJECTIVE: To compare the costs and clinical consequences of treating mild-to-moderate joint bleeds with recombinant activated factor VII (rFVIIa) versus plasma-derived activated prothrombin complex concentrate (pd-aPCC) in pediatric patients with hemophilia A with inhibitors in Mexico. METHODS: A cost-effectiveness model was developed using TreeAge Pro v14.2.2 software (licensed in the USA) and adapted from a previously published model, with adjustments to reflect local clinical practice. Expert opinion was sought regarding patients' clinical management and resource utilization in Mexico to ensure that the current model was appropriate and relevant. The model compared rFVIIa and pd-aPCC for the treatment of mild-to-moderate joint bleeds in children <14 years old (assumed average weight: 30 kg). The analysis outcome was incremental cost per resolved mild-to-moderate joint bleed. One-way sensitivity analysis and probabilistic sensitivity analysis were used to assess specific assumptions and to address any uncertainty in the model. RESULTS: The cost of treating mild-to-moderate joint bleeds was lower for rFVIIa versus pd-aPCC after 7 days (MX$105,581 vs. MX$132,024), assuming complete bleed resolution. After 48 hours, rFVIIa was associated with an 8% improvement in bleed resolution versus pd-aPCC, resulting in cost savings of MX$16,754. Probabilistic sensitivity analysis indicated that rFVIIa treatment was more cost-effective than pd-aPCC in 67% (at 7 days) and 72% (at 48 hours) of Monte Carlo simulations. CONCLUSION: Accounting for model uncertainty, rFVIIa provided cost savings over pd-aPCC for the Mexican public health care payer in the management of mild-to-moderate joint bleeds in pediatric hemophilia A with inhibitors.

Identification of organic compounds in San Diego de los Baños Peloid (Pinar del Río, Cuba).

BACKGROUND: Natural organic compounds with biologic activity have extensive use in the treatment of many diseases, and are of great interest both as natural products and as precursors for synthetic strategies. Thermal muds ("peloids") are a typical example of natural products that contain organic compounds with biologic activity, which allows their use in the treatment of different pathologies. More recently, these thermal muds have found an increasing use in relaxation therapies in health spas. MATERIALS AND METHODS: This study was performed to characterize the organic composition of San Diego de los Baños peloid (Pinar del Río, Cuba). For this purpose, a procedure for the extraction and chromatographic analysis has been developed, taking into account sample preparation, elimination of interferences, chromatographic separation of the organic compounds, and identification by mass spectrometry. RESULTS: More than 50 compounds were identified in the San Diego de los Baños peloid, mainly of natural origin. Among them were found alkanes, the 4 phenyl valeric acid, 5 isopentyl picolinic acid, 3 hydroxylauric acid, (5α, 3ß) 3-hydroxy-11-androstanone, the 5α-2-en-11 androstenone, squalene, terpinol (α terpineol), menthol derivatives (1 butyn 3 one 1 yl menthol), the palmitic, oleic, and eicosanoic acids, and the isoprenoid phytane. These compounds have reportedly shown biologic activity in their isolated form as antioxidant, analgesic, anti-inflammatory, immune stimulant, antineoplastic, detoxicant, membrane regulator, and hormones. CONCLUSIONS: These results provide strong evidence for medical interpretation of the well-known therapeutic action of San Diego de los Baños peloid in the treatment of inflammatory and dermatological diseases, as analgesic, in male and female infertility therapies, and with cosmetic purposes. Furthermore, this systematic work contributes to the fundamental understanding of pelotherapy, giving some scientific basis for its future development.

Fibronectina en productos sanguíneos / Plasma fibronectin concentration in blood products

Objetivo. Determinar las concentraciones de fibronectina (FBN) en tres diferentes unidades sanguíneas disponibles en el Banco de Sangre del Instituto Nacional de Pediatría, para su utilización como posibles fuentes de administración exógena temporal de esta glicoproteína en pacientes pediátricos con deficiencia o como coadyuvante en el tratamiento de pacientes en estado crítico. Material y métodos. Se determinó la concentración de FBN en 14 unidades de sangre fresca, 14 unidades de plasma congelado y 15 crioprecipitados, obtenidos y disponibles en el banco de Sangre del Instituto Nacional de pediatría, mediante nefelometría. Resultados. La concentración de FBN en sangre fresca fue (x ñ DS) 483 ñ 230 µg/L, en plasma congelado 111 ñ 74 µg/L y en crioprecipitados 2107 ñ 682 µg/L con una diferencia estadísticamente significativa (P <0.001). Se observó que la concentración de FBN en las unidades sanguíneas almacenadas se reduce significativamente conforme se incrementa el tiempo de almacenaje. Conclusiones. La unidad sanguínea apropiada para proporcionar cantidad suficiente de fibronectina es el crioprecipitado. Las unidades recien obtenidas contienen las concentraciones más elevadas