Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España / Budget impact analysis of the XEN®63 for the treatment of primary open angle glaucoma in Spain

Antecedentes y objetivo Evaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodos Se diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones poscirugía, se emplearon datos de la literatura y se validaron con un panel de cuatro expertos. Los costes unitarios (€de2021) se obtuvieron de la base de datos ESALUD Resultados la inclusión de XEN®63 podría generar un ahorro de 2.569.737€ tras un año desde su introducción, derivado del ahorro en el coste del implante y del procedimiento (−423.120; −0,7%), de las visitas de seguimiento (−777.407€; −4,5%), de los procedimientos adicionales (−1.048.145€, −20,6%) y de las complicaciones poscirugía (−321.065€, −14,2%). Conclusiones La incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS (AU)

Background and objective To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methods A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1year. The comparators considered (trabeculectomy, deep non-perforating sclerectomy, Ahmed valve, iStent inject®, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€2021) were obtained from the ESALUD database. Result The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−€423,120; −0.7%), follow-up visits (−€777,407; −4.5%), additional procedures (−1,048,145; −20.6%) and post-surgery complications (−€321,065; −14.2%). Conclusion The incorporation of XEN®63 in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS (AU)

Budget impact analysis of the XEN®63 for the treatment of primary openangle glaucoma in Spain.

BACKGROUND AND OBJECTIVE: To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. MATERIALS AND METHODS: A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€ 2021) were obtained from the ESALUD database. RESULTS: The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (-€423,120; -0.7%), follow-up visits (-€777,407; -4.5%), additional procedures (-€1,048,145; -20.6%) and post-surgery complications (-€321,065; -14.2%). CONCLUSIONS: The incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS.

Guía de estilos de vida y glaucoma (i). Deporte y actividades / Lifestyles guide and glaucoma (i). Sports and activities

Objetivos: El aumento de la calidad y de la esperanza de vida y el hecho de que el glaucoma se diagnostique cada vez más precozmente hace preguntarse a muchos pacientes si afectan a su enfermedad determinados deportes, actividades o aficiones. El objetivo de este trabajo es establecer unas guías para aconsejar a los pacientes con base en la evidencia científica de los trabajos publicados. Métodos: Revisión de todos los trabajos publicados sobre glaucoma y deportes u otras actividades. Los trabajos fueron clasificados según el nivel de evidencia científica basada en la clasificación del Oxford Centre for Evidence-Based Medicine. Resultados: Las actividades aeróbicas son beneficiosas para el paciente. Se han de evitar deportes o técnicas de relajación tipo yoga con maniobras de Valsalva o colocación de la cabeza en posición inferior. También se deben evitar los cambios bruscos en altura. El calor intenso no parece influir en el glaucoma, pero el frío intenso puede afectar a pacientes con disregulación vascular. Las actividades de visión próxima disminuyen levemente la presión intraocular. El uso de instrumentos de viento puede elevar la presión intraocular dependiendo de la técnica utilizada. Conclusiones: Ciertos deportes y actividades pueden tener una influencia en la aparición o la progresión del glaucoma. Los especialistas en glaucoma deben tener información adecuada sobre la evidencia científica de las publicaciones para poder aconsejar apropiadamente a los pacientes (AU)

Purposes: The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. Methods: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. Results: Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva manoeuvres are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. Conclusions: Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients (AU)

Guía de estilos de vida y glaucoma (II). Dieta, suplementos, drogas, sueño, embarazo e hipertensión arterial / Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension

Objetivos: Establecer guías para aconsejar a los pacientes respecto a la relación entre dieta y hábitos de vida y glaucoma. Métodos: Revisión de los trabajos publicados sobre glaucoma y la dieta, la ingesta de suplementos, el consumo de drogas o el tabaco, el sueño, el embarazo y la hipertensión. Los trabajos fueron clasificados según el Oxford Center for Evidence-Based Medicine. Resultados: La evidencia sobre la relación entre la dieta o el uso de suplementos y la incidencia o la progresión del glaucoma es insuficiente para justificar una recomendación. Si bien algunos estudios en glaucoma de tensión normal sugieren que el Ginkgo biloba podría reducir la progresión, no permiten recomendar su uso generalizado. Los estudios sobre tabaco no demuestran claramente una relación entre consumo de tabaco e incidencia del glaucoma. La marihuana no es un tratamiento útil para el glaucoma. Los resultados sobre la relación entre la apnea del sueño y glaucoma son heterogéneos, pero sí parece conveniente que los pacientes con grado moderado o severo de apnea sean evaluados para descartar glaucoma. El embarazo no suele afectar al curso de la enfermedad, pero varios medicamentos hipotensores pueden ser nocivos para el feto. La hipotensión nocturna es un factor de riesgo de empeoramiento del glaucoma. Conclusiones: Ciertas costumbres, circunstancias o enfermedades pueden tener una influencia en la aparición o progresión del glaucoma. Es importante conocer la evidencia científica existente para poder aconsejar adecuadamente a los pacientes (AU)

To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. Methods: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. Results: The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. Conclusions: Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients (AU)

Lifestyles guide and glaucoma (i). Sports and activities. / Guía de estilos de vida y glaucoma (i). Deporte y actividades.

PURPOSES: The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. METHODS: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva manoeuvres are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. CONCLUSIONS: Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients.

Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension. / Guía de estilos de vida y glaucoma (II). Dieta, suplementos, drogas, sueño, embarazo e hipertensión arterial.

PURPOSE: To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. METHODS: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. RESULTS: The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. CONCLUSIONS: Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients.

Comparison of diagnostic methods for Helicobacter pylori infection in patients with upper gastrointestinal bleeding.

BACKGROUND: Accuracy of the most frequently used tests for diagnosing Helicobacter pylori infection in patients with upper gastrointestinal bleeding of peptic origin is determined. METHODS: Seventy-eight patients with endoscopically-proven upper gastrointestinal bleeding of peptic origin were included. The presence of H. pylori was considered when observed from the histology or, if negative, when serology and breath test were both positive. Accuracy of the rapid urease test was estimated in accordance with results obtained with other diagnostic methods. RESULTS: Lesions causing gastrointestinal bleeding were 56 duodenal ulcers, 13 gastric ulcers, 7 pyloric channel ulcers, 13 acute lesions of the gastric mucosa and 16 erosive duodenitis. H. pylori infection was present in 68 patients (87.2%). Forty-four patients had received non-steroidal anti-inflammatory drugs. The sensitivity/specificity (%) of the diagnostic methods was 48.5/100 for the rapid urease test, 91/77.8 for the breath test, 89.5/80 for serology and 86.3/100 for histology. The prior consumption of proton-pump inhibitors and antibiotics induced false-negative results in the rapid urease test and breath test, with no effect on serology and histology. CONCLUSIONS: The prevalence of H. pylori infection in patients with upper gastrointestinal bleeding from peptic lesions is high. Sensitivity of the rapid urease test for diagnosing H. pylori is low in this setting. Cases with negative rapid urease test need the combination of two or more additional tests if diagnosis is to be achieved. Cases with positive rapid urease test do not need further investigation for diagnosis.

[Abdominal scintigraphy with 99MTc-HMPAO-labelled leukocytes. Utility of the quantification in the evaluation of the inflammatory activity of Crohn's disease and ulcerative colitis]. / Gammagrafía abdominal con leucocitos-HMPAO-99mTc. Utilidad de la cuantificación en la evaluación de la actividad inflamatoria de la enfermedad de Crohn y colitis ulcerosa.

We aimed to determine the activity of Crohn's Disease (CD) and Ulcerative Colitis (UC) with this radiotracer and to compare it with the normal clinical indexes. 32 patients with CD (19 women) and 18 with UC (13 women) were studied and a sequential abdominal 99mTc-HMPAO-label leukocyte scintigraphy was performed after evaluating the activity clinical scales indexes (Harvey's for CD and Lictiger for UC). Quantification was performed to obtain intestinal activity indexes in regards to intestinal uptake with background, bone marrow, liver and spleen, comparing them with the clinical indexes. In CD, all scintigraphic indexes showed a significant correlation (p < 0.001) with clinical activity. The best results were obtained with gut/background (r: 0.73) and gut/bone marrow (r: 0.72). In UC, we obtain a lower correlation between clinical and scintigraphic indexes. Significant correlations (p < 0.05) were only found with the gut/background (r: 0.52) and gut/bone marrow growth indexes (r: 0.58). The others showed no correlation. In conclusion, IBD activity estimated with 99mTc-WBC and scintigraphy indexes showed moderate correlation with clinical scales. However, the information of the scintigraphy was very useful in the management of these patients.

[Reye's syndrome in adults. Presentation of a new case and review of the literature]. / Síndrome de Reye en el adulto. Presentación de un nuevo caso y revisión de la literatura.

This is the case of a 29 year-old woman, admitted because of diarrhea and incoercible vomiting; later in the course of the disease she developed signs and symptoms of encephalopathy. The diagnosis of Reye's syndrome was made after death.

Blockade of ovarian compensatory hypertrophy and ovulation in the rat by hypothalamic implants of an anticholinergic drug.

PIP: The participation of a central cholinergic system in the control of hypophysial folliculotrophin release was confirmed in an experiment in which 250 gm of atropine sulfate, a blocking agent, was implanted in the anterior and lateral hypothalamic areas of rate; 22 rats were killed after 15 days, 24 after 30 days, and 10 were hemicastrated the same day of implantation and sacrificed 15 days later. A significantly prolonged diestrous phase from 4-12 days were observed in 43 of 46 intact rats implanted with atropine, suggesting an inhibition in the ovulatory discharge of gonadotrophins; lowered ovarian weight after 15 days due to a decrease in number and diameter of corpora lutea indicated that the drug may mainly affect the release of luteinizing hormone. Normal ovarian weight, morphology, and ovulatory activity was resumed after 30 days indicating that the blockade of ovulation was a transient consequence of the neural action of atropine. Ovarian compensatory hypertrophy in hemicastrated rats was prevented by the same dose of atropine but without disturbance in the estrous cycle, indicating incomplete inhibition of folliculotrophin release.^ieng