Gasto en el último año de vida para pacientes que mueren con cáncer / Last-year-of-life expenditure of patients diagnosed with cancer

Resumen Objetivo: Estimar el gasto en el último año de vida de los pacientes diagnosticados con cáncer para Colombia. Métodos: Estudio retrospectivo descriptivo con datos de la facturación de dos EPS para los años 2011-2013. Se calculó el gasto en el último año de vida para la cohorte de pacientes fallecidos durante este tiempo. Se identificaron los pacientes que hubieran sido diagnosticados con cáncer en el año de la muerte usando códigos CIE-10. Se define gasto en el último año de vida como servicios prestados desde la fecha de muerte y los 360 días previos. Resultados: El 30,4% de los fallecidos de la cohorte tenían un diagnóstico de cáncer. Del total del gasto de todos los fallecidos en su último año de vida, el 43,6% del gasto correspondía a personas diagnosticadas con cáncer en 2012 y el 40% en 2013. El gasto medio para pacientes fallecidos por cáncer es entre 72% y 76% más alto que aquellos que no. El gasto mensual es más alto en los meses más cercanos a la muerte. Conclusiones: El uso de recursos de los pacientes que fallecen por cáncer podría disminuirse con programas de cuidado paliativo que respetan la calidad de vida de los pacientes.

Abstract Objective: To estimate last-year-of-life expenditure for patients diagnosed with cancer in Colombia. Methods: This is a descriptive retrospective study. Using claims data for two HMO for years 20112013, last-year-of-life expenditure was estimated for all persons dying in 2012-2013. Cancer diagnoses were identified using ICD-10 codes. Last-year-of-life expenditure was defined as allservices provided between the date of death and the 360 days previous. Results: A cancer diagnosis was recorded in 30.4% of the deceased and accounted for 43.6% of total last-year-of-life expenditure in 2012, and 40% in 2013. The mean per deceased expenditure was between 72% and 76% higher for patients with cancer as compared to patients without cancer. Last-year-of-life expenditure increases with the proximity to death. Conclusion: The use of resources for people dying with cancer diagnosis could be reduced with palliative care programs that give patients a quality of life.

Mutation distribution in the NSP4 protein in rotaviruses isolated from Mexican children with moderate to severe gastroenteritis.

The NSP4 protein is a multifunctional protein that plays a role in the morphogenesis and pathogenesis of the rotavirus. Although NSP4 is considered an enterotoxin, the relationship between gastroenteritis severity and amino acid variations in NSP4 of the human rotavirus remains unclear. In this study, we analyzed the sequence diversity of NSP4 and the severity of gastroenteritis of children with moderate to severe gastroenteritis. The rotavirus-infected children were hospitalized before the rotavirus vaccine program in Mexico. All children had diarrhea within 1-4 days, 44 (88%) were vomiting and 35 (70%) had fevers. The severity analysis showed that 13 (26%) cases had mild gastroenteritis, 23 (46%) moderate gastroenteritis and 14 (28%) severe. NSP4 phylogenetic analysis showed three clusters within the genotype E1. Sequence analysis revealed similar mutations inside each cluster, and an uncommon variation in residue 144 was found in five of the Mexican NSP4 sequences. Most of the amino acid variations were located in the VP4 and VP6 binding site domains, with no relationship to different grades of gastroenteritis. This finding indicates that severe gastroenteritis caused by the rotavirus appears to be related to diverse viral or cellular factors instead of NSP4 activity as a unique pathogenic factor.

Extracts of edible and medicinal plants in inhibition of growth, adherence, and cytotoxin production of Campylobacter jejuni and Campylobacter coli.

UNLABELLED: Campylobacter spp. is recognized as one of the most common cause of food-borne bacterial gastroenteritis in humans. Campylobacter infection causes campylobacteriosis, which can range from asymptomatic to dysentery-type illnesses with severe complications, such as Guillian-Barre syndrome. Epidemiological studies have revealed that consumption of poultry products is an important risk factor of this disease. Adherence and cytotoxic activity of the bacteria to host mucosal surfaces have been proposed to be critical steps in pathogenesis. Innovative tools for controlling Campylobacter, such as natural products from plants, represent good alternatives for use in foods or as therapeutic agents. In this study, 28 edible or medicinal plants species were analyzed for their bactericidal effects on the growth of Campylobacter jejuni and C. coli. The extracts of Acacia farnesiana, Artemisia ludoviciana, Opuntia ficus-indica, and Cynara scolymus were the most effective against these microorganisms at minimal bactericidal concentrations (MBCs) of 0.3, 0.5, 0.4, and 2.0 mg/mL, respectively. No effect on growth was detected with lower concentrations of extract (25%, 50%, or 75% of the MBC) added to the media. The effect of each extract (75% of the MBC) on adherence and cytotoxicity of C. jejuni and C. coli was evaluated in Vero cells. Adherence of Campylobacter to Vero cells was significantly affected by all the extracts. Cytotoxic activity of bacterial cultures was inhibited by A. farnesiana and A. ludoviciana. These plant extracts are potential candidates to be studied for controlling Campylobacter contamination in foods and the diseases associated with this microorganism. PRACTICAL APPLICATION: Innovative tools for controlling Campylobacter, such as natural products from plants, represent good alternatives for use in foods or as therapeutic agents. The extracts of Acacia farnesiana, Artemisia ludoviciana, Opuntia ficus-indica, and Cynara scolymus were the most effective against these microorganisms. Adherence and cytotoxic activity of the bacteria to host mucosal surfaces which are critical steps in pathogenesis were decreased by these extracts. Our results point to these plants as potential candidates for the control of Campylobacter contamination in foods, the treatment of the diseases associated with this microorganism, and as feed supplements to reduce on-farm prevalence of Campylobacter.

Prevalence and genetic diversity of human astroviruses in Mexican children with symptomatic and asymptomatic infections.

The prevalence and type diversity of human astroviruses (HAstV) in children with symptomatic and asymptomatic infections were determined in five localities of Mexico. HAstV were detected in 4.6 (24 of 522) and 2.6% (11 of 428) of children with and without diarrhea, respectively. Genotyping of the detected strains showed that at least seven (types 1 to 4 and 6 to 8) of the eight known HAstV types circulated in Mexico between October 1994 and March 1995. HAstV types 1 and 3 were the most prevalent in children with diarrhea, although they were not found in all localities studied. HAstV type 8 was found in Mexico City, Monterrey, and Mérida; in the last it was as prevalent (40%) as type 1 viruses, indicating that this astrovirus type is more common than previously recognized. A correlation between the HAstV infecting type and the presence or absence of diarrheic symptoms was not observed. Enteric adenoviruses were also studied, and they were found to be present in 2.3 (12 of 522) and 1.4% (6 of 428) of symptomatic and asymptomatic children, respectively.

Rotavirus diarrhea severity is related to the VP4 type in Mexican children.

This report is of a community-based case control study to assess whether the severity of acute diarrhea by rotavirus (RV) in young children is associated with a particular VP7 (G) or VP4 (P) RV serotype. Five hundred twenty children younger than 2 years of age with diarrhea lasting less than 3 days were age and gender matched with 520 children with no diarrhea. The G and P serotypes were determined with specific monoclonal antibodies, and the VP4 serotype specificity in a subgroup was confirmed by genotyping. Infection with a G3 serotype led to a higher risk of diarrhea than infection with a G1 serotype. Infection with a G3-nontypeable-P serotype was associated with more severe gastroenteritis than infection with a G3 (or G1) P1A[8] serotype. A child with diarrhea-associated dehydration was almost five times more likely to be infected with a G3-nontypeable-P serotype than a child without dehydration (P < 0.001). Moreover, the two predominant monotypes within serotype P1A[8] had significantly different clinical manifestations. In this study, the severity of RV-associated diarrhea was related to different P serotypes rather than to G serotypes. The relationship between serotype and clinical outcomes seems to be complex and to vary among different geographic areas.