Cost-effectiveness of intravascular ultrasound-guided percutaneous intervention in patients with acute coronary syndromes: A UK perspective.

BACKGROUND: Use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes over angiography alone. Despite this, the adoption of IVUS in clinical practice remains low. AIMS: To examine the cost-effectiveness of IVUS-guided PCI compared to angiography alone in patients with acute coronary syndromes (ACS). METHODS: A one-year decision tree and lifetime Markov model were constructed to compare the cost-effectiveness of IVUS-guided PCI to angiography alone for two hypothetical adult populations consisting of 1,000 individuals: ST-elevation myocardial infarction (STEMI) and unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients undergoing drug-eluting stent (DES) implantation. The UK healthcare system perspective was applied using 2019/20 costs. All-cause death, myocardial infarction (MI), repeat PCI, lifetime costs, life expectancy and quality-adjusted life-years (QALYs) were assessed. RESULTS: Over a lifetime horizon, IVUS-guided PCI was cost-effective compared to angiography alone in both populations, yielding an incremental cost-effectiveness ratio of £3,649 and £5,706 per-patient in STEMI and UA/NSTEMI patients, respectively. In the one-year time horizon, the model suggested that IVUS was associated with reductions in mortality, MI and repeat PCI by 51%, 33% and 52% in STEMI and by 50%, 29% and 57% in UA/NSTEMI patients, respectively. Sensitivity analyses demonstrated the robustness of the model with IVUS being 100% cost-effective at a willingness-to-pay (WTP) threshold of £20,000 per QALY-gained. CONCLUSIONS: From a UK healthcare perspective, an IVUS-guided PCI strategy was highly cost-effective over angiography alone amongst ACS patients undergoing DES implantation due to the medium- and long-term reduction in repeat PCI, death, and MI.

PROCare4Life lessons learned.

PeRsOnalised Integrated CARE Solution for Elderly (PROCare4Life) was an EU-funded project that ran from January 2020 until June 2023, whose focus was to further develop and integrate previous ICT solutions developed by several previous EU-funded projects into a unique modular system able to support the autonomy and empowerment and to increase the Quality of Life (QoL) of elderly people living with Parkinson's, Alzheimer's, or similar dementia, having also tested the system for elderly people living with comorbidities. This article focuses on the methodology and results used to identify the internal lessons learned. PROCare4Life was developed using a codesign approach involving more than 2,000 participants whose input has been listened to and transformed into valuable changes of the system and also into lessons learned included in this case study report. Since the beginning of the implementation of PROCare4Life, there has been a commitment to make invisible knowledge visible through open discussion and including our lessons learned in each of our deliverables. In the last six months of implementation, qualitative research has been implemented by the PROCare4Life consortium to identify and select our most relevant challenges and recommendations for future projects and initiatives. PROCare4Life was highly impacted by the COVID-19 pandemic, and it is acknowledged in the lessons learned. However, the consortium has focused on the recommendations that could be more valuable for ordinary implementation of future projects and initiatives developing eHealth tools for elderly citizens living with conditions that might affect their cognitive or mobility capacities.

PeRsOnalised Integrated CARE Solution for Elderly (PROCare4Life) was an EU-funded project that ran from January 2020 until June 2023, aiming at improving the quality of life of older people living with Parkinson's, Alzheimer's or other dementia using ICT technologies. The term implementation refers to the process of putting a plan or idea into action. It is a complex process that involves multiple stages, including planning, execution, and evaluation. Implementation research is a growing field of health research that aims to study the factors that affect the implementation of health policies, programs, and practices. It can help identify the best strategies for introducing potential solutions into a health system or promoting their large-scale use and sustainability. For PROCare4Life, when using the term implementation it covers all the stages, including ideation and design phases, although focusing on the pilot 3 iterative codesign and testing of the system. Using daily life devices such as smartphones and smart watches, more than 2,000 people have contributed to co-creating PROCare4Life. The three profiles focused on were older people living with Parkinson's, Alzheimer's or other dementia, their main carers and their healthcare professionals, with an ICT system providing direct communication and allowing them to share their health status. Along the journey to develop PROCare4Life, our European consortium has learned many things that we have internally investigated and reported in this article. We have identified 20 challenges and 41 recommendations. We hope that our lessons learned might be inspiring and valuable for others, particularly future projects and initiatives developing eHealth tools for elderly EU citizens living with different conditions that might affect their cognitive or mobility capabilities.

Fast venomic analysis of Crotalus durissus terrificus from northeastern Argentina

The complete knowledge of the toxins that make up venoms is the base for the treatment of snake accidents victims and the selection of specimens for the preparation of venom pools for antivenom production. In this work, we used a fast and direct venomics approach to identify the toxin families in the C.d. terrificus venom, a Southern American Neotropical rattlesnake. The RP-HPLC separation profile of pooled venom from adult specimens followed by mass spectrometry analysis revealed that C.d. terrificus’ venom proteome is composed of 12 protein families, which are unevenly distributed in the venom, e.g., there are few major proteins in the venom's composition phospholipase A2, serine proteinase, crotamine and L-amino acid oxidase. At the same time, the proteome analysis revealed a small set of proteins with low quantity (less than 1.5%), both enzymes (metaloprotease, phospholipase B and 5′-nucleotidase) and proteins (Bradykinin potentiating and C-type natriuretic peptides, C-type lectin convulxin and nerve growth factor). To sum up, this research is the first venomic report of C.d.terrificus venom from Argentina. This proved to be crotamine positive venom that has a lower metalloprotease content than C.d. terrificus venoms from other regions. This information could be used in the discovery of future pharmacological agents or targets in antivenom therapy.

BmajPLA(2)-II, a basic Lys49-phospholipase A(2) homologue from Bothrops marajoensis snake venom with parasiticidal potential

Snake venoms contain various proteins, especially phospholipases A(2) (PLA(2)s), which present potential applications in diverse areas of health and medicine. In this study, a new basic PLA(2) from Bothrops marajoensis with parasiticidal activity was purified and characterized biochemically and biologically. B. marajoensis venom was fractionated through cation exchange followed by reverse phase chromatographies. The isolated toxin, BmajPLA(2)-II, was structurally characterized with MALDI-TOF (Matrix-assisted laser desorption/ionization-time of flight) mass spectrometry, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), followed by two-dimensional electrophoresis, partial amino acid sequencing, an enzymatic activity assay, circular dichroism, and dynamic light scattering assays. These structural characterization tests presented BmajPLA(2)-II as a basic Lys49 PLA(2) homologue, compatible with other basic snake venom PLA(2)s (svPLA(2)), with a tendency to form aggregations. The in vitro anti-parasitic potential of B. marajoensis venom and of BmajPLA(2)-II was evaluated against Leishmania infantum promastigotes and Trypanosoma cruzi epimastigotes, showing significant activity at a concentration of 100 mu g/mL. The venom and BmajPLA(2)-II presented IC50 of 0.14 +/- 0.08 and 6.41 +/- 0.64 mu g/mL, respectively, against intraerythrocytic forms of Plasmodium falciparum with CC50 cytotoxicity values against HepG2 cells of 43.64 +/- 1 7.94 and >150 mu g/mL, respectively. The biotechnological potential of these substances in relation to leishmaniasis, Chagas disease and malaria should be more deeply investigated.

Tumor triquilemal proliferante. Presentación de un caso / Trichilemmal proliferating tumor. Case report

Introducción: el Tumor Triquilemal Proliferante es un tumor con diferenciación hacia estructuras pilosas, generalmente se presenta como un nódulo solitario en el cuero cabelludo en mujeres de edad avanzada. es considerado benigno pero con un comportamiento incierto dada su agresividad local y tendencia a la recidiva. Su característica histológica principal es la presencia de queratinización triquilemal. Objetivo: hacer una caracterización clínica e histopatológica de esta entidad. Presentación del caso: se presenta un caso de un Tumor Triquilemal Proliferante en el cuero cabelludo de una mujer de 66 años como un nódulo solitario. Se explican los resultados del estudio y la importancia de su diagnóstico preciso dada la posibilidad de su confusión con otras lesiones cutáneas como el quiste epidérmico. Conclusiones: el Tumor Triquilemal Proliferante es una entidad a tener en cuenta en el diagnóstico diferencial de lesiones tumorales en el cuero cabelludo con características distintivas específicas.

Introduction: proliferating trichilemmal tumor is tumor with follicular isthmus, that usually presents as a solitary nodule on the scalp of elderly women. It is considered a benign neoplasm but with an uncertain behavior because of its local aggressiveness and recidivant tendency. Its main histological characteristic is the presence of trichilemmal keratinization. Objective: to make a clinical and histopathological characterization of this condition. Case presentation: we describe a case of a Proliferating trichilemmal tumor on the scalp of a 66-year-old female, presenting as a solitary nodule. Results of the anatomo-pathological study are presented emphasizing in the importance of its precise diagnosis because the possibility of confusion with other cutaneous conditions like epidermal cyst. Conclusions: proliferating trichilemmal tumor is an entity to keep in mind in the differential diagnosis of tumoral lesions of the scalp with distinctive and specific characteristics.

Perfil socio económico del médico del Hospital Nacional de Itauguá

Estúdiase la situación socio-económica de médicos del Hospital Nacional de Itauguá. Se basa en los datos obtenidos de una investigación...

Efectos e interacciones recíprocas de la profundidad de la retención dental, la localización anatómica y la celularidad epitelial en el saco pericoronario de los dientes retenidos / Effects and reciprocal interactions of the depth of dental retention, anatomical location and epithelial cellularity in the pericoronal sac of impacted teeth

La investigación se realizó con el propósito de conocer si se producen modificaciones significativas de la concentración celular epitelial en las diferentes profundidades óseas en que puede manifestarse la retención dental. Se estudiaron 55 sacos pericoronarios extraídos de pacientes menores de 20 años. Las medidas de las profundidades de retención dental se realizaron mediante sondas parodontales milimetradas, y se estimaron como profundidades las menores distancias perpendiculares desde los puntos más prominentes de las cúspides dentales más profundas a los planos horizontales superficiales óseos. Se estimó como nivel No 1 de profundidad cuando la distancia era menor de 3 milímetros y nivel No. 2 cuando ésta era de 3 o más milímetros. Otras variables analizadas fueron las localizaciones anatómicas maxilares y madibulares en que se encontraban los dientes retenidos. La variable celularidad se definió como la existencia o ausencia de células epiteliales. Las evaluaciones estadísticas se realizaron utilizando la técnica de "Estimación de un modelo de ajuste logarítmico lineal para tablas de contingencia". El proceso matemático de los datos fue realizado en una microcomputadora NED y se realizó de acuerdo con el estadígrafo G* de la distribución chi-cuadrado. Se obtuvieron 17 posibles combinaciones de las variables, analizándose los efectos de las 3 variables por separado y sus interacciones recíproca. Los resultados de este análisis determinaron que se rechaza la posibilidad de interacción entre profundidad y localización anatómica, y entre la profundidad y la celularidad, y que es posible aceptar la existencia de una fuerte interacción entre la localización anatómica y la celularidad epitelial

Mortalidad intraparto: enero de 1978 a diciembre de 1983 / Intrapartum mortality: january 1978-december 1983

Se realiza un estudio de 148 muertes intraparto ocurridas. Se utilizan en este estudio los criterios de mortalidad intraparto de la investigación de mortalidad inglesa, 1958 y de la investigación perinatal cubana, 1973, que definen como mortalidad intraparto a las defunciones que ocurren en fetos recién nacidos como consecuencia de anoxia intraparto y trauma y excluyen las defunciones intraparto por otras causas como malformaciones congénitas, isoinmunización y otras específicas. Se realiza, en 1973 en nuestro país, una investigación nacional de mortalidad perinatal, con el objetivo de describir las características de la morbimortalidad, relacionarla con factores biológicos y sociales capaces de afectarla y evaluar la calidad de la atención médica ofrecida a la población. Se informa que para la elaboración y ejecución de esa encuesta sirvió de modelo la realizada en Inglaterra en 1958 y publicada en 1963 con el título de Perinatal Problems

Análisis de las lesiones faciales por traumatismos en niños que motivaron la hospitalización en un período de 2 años / Analysis of facial lesions in children due to traumatisms causing hospitalization during a 2 year period

Se realiza un análisis retrospectivo en 119 pacientes ingresados por traumatismo facial durante los años l981-1982. Se encuentra que el grupo de edad más afectado fue el de 9 a ll años, el sexo masculino constituyó el 73,9% de los pacientes. La principal causa de lesión fueron las caídas con 56 y la lesión más frecuente resultó la fractura nasal con 76. Se plantea que el tratamiento conservador constituyó el más utilizado en las fracturas mandibulares