Efficient use of mepolizumab in children: An analysis of the economically justifiable price in Colombia.

INTRODUCTION: Asthma imposes a crucial economic burden on health systems, especially with the incorporation of new drugs. Recently, mepolizumab has been approved to prevent exacerbations in patients with eosinophilic asthma. This study explores the economically justifiable price of mepolizumab for preventing exacerbations in children with severe asthma. MATERIALS AND METHODS: A model was developed using the microsimulation to estimate the quality-adjusted costs and life years of two interventions: mepolizumab versus not applying standard treatment without mepolizumab. This analysis was made during a time horizon of 50 years and from a third-payer perspective. RESULTS: Mepolizumab was cost-effective using a WTP of U$ 19,992 per QALY, but not at a WTP of U$ 4828, U$ 5128 per QALY. The economically justifiable cost for mepolizumab in Colombia is between $33 and $350 per dose, for WTP of U$ 4828, and U$ 5128 respectively. At the current price of Mepolizumab, U$ 780 per dose, only using a WTP higher than U$ 10,300 per QALY mepolizumab will be the best alternative to no mepolizumab. CONCLUSION: Our study shows that the economically justifiable cost for mepolizumab in Colombia is between $33 and $350 per dose, for WTP of 4828 and 5180 respectively. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Myoclonus induced by salbutamol: A case report

Salbutamol is a ß2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the ß2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

Mioclonías inducidas por salbutamol / Myoclonus induced by salbutamol: A case report

Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.

Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

Sustainable Cattle Ranching in Practice: Moving from Theory to Planning in Colombia's Livestock Sector.

A growing population with increasing consumption of milk and dairy require more agricultural output in the coming years, which potentially competes with forests and other natural habitats. This issue is particularly salient in the tropics, where deforestation has traditionally generated cattle pastures and other commodity crops such as corn and soy. The purpose of this article is to review the concepts and discussion associated with reconciling food production and conservation, and in particular with regards to cattle production, including the concepts of land-sparing and land-sharing. We then present these concepts in the specific context of Colombia, where there are efforts to increase both cattle production and protect tropical forests, in order to discuss the potential for landscape planning for sustainable cattle production. We outline a national planning approach, which includes disaggregating the diverse cattle sector and production types, identifying biophysical, and economic opportunities and barriers for sustainable intensification in cattle ranching, and analyzing areas suitable for habitat restoration and conservation, in order to plan for both land-sparing and land-sharing strategies. This approach can be used in other contexts across the world where there is a need to incorporate cattle production into national goals for carbon sequestration and habitat restoration and conservation.

Estudio retrospectivo de cohorte sobre el antecedente de síndrome de abstinencia al alcohol y su asociación con delírium trémens en hospitalizaciones posteriores, Medellín, 2010-2012 / History of alcohol withdrawal syndrome and its association with delirium tremens on later hospitalizations: retrospective cohort study

Introducción: el consumo excesivo de alcohol es un problema de salud pública a nivel mundial que ocasiona anualmente, según la Organización Mundial de la Salud, 2,5 millones de muertes. En Colombia, el 11% de los mayores de 15 años cumple los criterios de abuso de alcohol del DSM-IV, con las consecuencias personales, legales y sociales que este implica, incluyendo las complicaciones asociadas al consumo crónico como el síndrome de abstinencia al alcohol y el delírium trémens. Objetivo: determinar si el antecedente de síndrome de abstinencia al alcohol se asocia con una mayor aparición de delírium trémens en pacientes atendidos por este síndrome en la ciudad de Medellín entre agosto de 2010 y julio de 2012. Materiales y métodos: se realizó un estudio de cohorte retrospectivo, comparando pacientes con y sin antecedente de síndrome de abstinencia al alcohol y el desarrollo de delírium trémens, además de otras posibles asociaciones como disfunción hepática y desequilibrios electrolíticos. El análisis de los datos fue de tipo bivariado, por medio de las pruebas estadísticas c2, Fisher y Mann Whitney. Resultados: se incluyeron 60 pacientes, en las características de base el 67% presentaron síndrome de abstinencia a alcohol, y 22% tuvieron antecedente de delírium trémens. Durante la estancia hospitalaria 56% de los sujetos desarrollaron delírium trémens. El antecedente de síndrome de abstinencia al alcohol no se asoció con desarrollar delírium trémens (p=0,26). En tanto que el antecedente de delírium trémens se comportó como un factor de riesgo para presentarlo nuevamente (p=0,02). Conclusión: el antecedente de síndrome de abstinencia al alcohol no se encontró relacionado con el desarrollo de delírium trémens en hospitalizaciones posteriores, en tanto que el antecedente de delírium trémens está asociado con la aparición de nuevos episodios. (MÉD.UIS. 2014;27(1):17-23).

Introduction: alcohol abuse is a public health problem around the world, which causes 2.5 million deaths per year according to the World Health Organization. In Colombia, 11% of the male population older than 15 years fulfills the DSM-IV criteria for alcohol abuse, with the personal, legal and social consequences that it entails, including those associated with chronic comsumption, such as withdrawal syndrome and delírium trémens. Objective: to establish if the history of alcohol withdrawal syndrome is related to a higher risk for development of delírium trémens in patients treated by this syndrome from the city of Medellin, between August of 2010 and July of 2012. Methods: this is a retrospective cohort study, with a comparison between patients with history of alcohol withdrawal syndrome and patients in their first episode, and the development of delírium trémens and the risk factors related with this. We did a bivariate analysis of the factors with the Mann Whitney, C2 and Fisher test. Results: 67% of the patients had a history of alcohol withdrawal syndrome and 22% showed previous episodes of delírium trémens. During hospitalization 56% of the subjects developed delírium trémens. The study showed that history of withdrawal syndrome is not a risk factor for the appearance of delírium trémens (p=0.26). In contrast, the record of delírium trérmens is a risk for new episodes (p=0.02). Conclusion: the history of alcohol withdrawal syndrome appears not to be a risk factor for the development of delírium trémens in a new hospitalization. On the other hand, the history of delírium trémens was associated with new episodes of delírium. (MÉD.UIS. 2014;27(1):17-23).