Health and economic impact associated with rheumatoid arthritis discharges: a cost analysis of a two-year cohort in Mexico.

BACKGROUND: Rheumatoid arthritis is a highly prevalent disease. Patients undergo various medical and pharmacological treatments, which have an economic impact on hospitals. The aim of this study was to estimate the direct economic costs of Mexican Social Security Institute (IMSS) resources used to provide healthcare to adult patients with rheumatoid arthritis in 2016-2017. METHODS: Data of patients aged > 18 years with Rheumatoid Arthritis (RA) were obtained from databases and public information sources to estimate the use of IMSS resources for the target population. Total costs were estimated by means of the macro-costing method, employing the diagnosis-related group (DRG). Each DRG of the IMSS was constructed with one of the diagnoses and the respective combination of clinical characteristics included in the ICD-9. This study was conducted from the national perspective of IMSS, the largest healthcare service administrator in the country. As such, it can be considered representative of the broader healthcare landscape in Mexico. RESULTS: The total cost per year of furnishing inpatient care to RA patients was found to be $170,099,794 MXN ($9,096,245.67 USD) for 2016 and $167,039,481 MXN ($8,932,592.57 USD) for 2017, implying an enormous economic impact on the government budget for Mexican public health services. CONCLUSIONS: Our results demonstrate that the direct costs of musculoskeletal and cardiovascular surgery represented the highest costs of RA in-hospital care at IMSS (the largest health institution in Mexico) in 2016 and 2017. Further studies are needed that include the cost of drugs and other indirect costs in addition to our results to get the most accurate approximation of the cost of living with RA.

The Impact of a History of Pre-maturity on Viral Respiratory Infections in Children Under 2 Years of Age: A Propensity Score-Matching Analysis of in-hospital Complications and Mortality.

Introduction: A history of pre-maturity may be a risk factor for complications in patients under 24 months of age hospitalized for viral respiratory infections (VRIs). Objective: To identify the impact of a history of pre-maturity on in-hospital complications and mortality in patients under 24 months of age who were hospitalized for VRIs over a period of 5 years. Material and Methods: This was a propensity score-matched study. The database was compiled by physicians, electronically validated by engineers, and analyzed by statisticians. Patients diagnosed with VRIs (based on International Classification of Diseases [ICD-10]) codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219, J22X, and J189) from 2013 to 2017 were enrolled in the study. The subjects were classified into two groups according to the absence or presence of a history of pre-maturity (P070, P072, P073). Patients with congenital heart disease (CHD) (Q20-Q26) were excluded. Length of hospital stay, in-hospital complications, surgical procedures, and mortality were analyzed. Statistical Analysis: Patients were matched according to age. For comparisons between groups, Student's t-tests and chi2 tests were applied. A logistic regression model was constructed to identify factors related to in-hospital complications and mortality. Results: In total, 5,880 patients were eligible for inclusion in the analysis. The average patient age was 14.25 weeks. The presence of pre-maturity (coefficient = 1.16), male sex, bronchopulmonary dysplasia (BPD), in-hospital infectious complications (coefficient = 11.31), and invasive medical procedures (coefficient = 18.4) increased the number of days of hospitalization. Invasive medical procedures (OR = 6.13), a history of pre-maturity (OR = 2.54), and male sex (OR = 1.78) increased the risk for in-hospital complications. In-hospital infectious complications (OR = 84.2) and invasive medical procedures (OR = 58.4) were risk factors for mortality. Conclusions: A history of pre-maturity increased the length of hospital stay and the rate of in-hospital complications but did not increase mortality in patients under 24 months of age hospitalized for VRIs.

Hospitalizations for viral respiratory infections in children under 2 years of age: epidemiology and in-hospital complications.

BACKGROUND: Viral respiratory infections (VRIs) are a frequent cause of hospitalization in children under 24 months of age. A history of prematurity or heart disease may be a risk factor for complications in patients hospitalized for VRI. The objective was to describe epidemiological data for children hospitalized for IRV and aged 1 to 24 months and to identify risk factors for the presence of in-hospital complications and mortality over a period of 5 years. METHODS: This was a cross-sectional study. Patients registered with VRI codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219 (based on International Classification of Diseases [ICD-10]) from 2013 to 2017 were included. Three subanalyses were performed to compare [1] patients with pathological history (prematurity, bronchopulmonary dysplasia [BPD] and congenital heart disease [CHD]), [2] diagnoses (pneumonia, acute bronchitis, and acute bronchiolitis), and [3] admission to the pediatric intensive care unit. Days of hospital stay, in-hospital complications, invasive medical procedure and mortality were analyzed. STATISTICAL ANALYSIS: VRI hospitalization prevalence was described. For comparison between groups, Student's t-test, ANOVA and the Chi2 test were applied. To identify factors related to days of hospital stay, in-hospital complications and mortality, a linear and logistic regression model was performed. RESULTS: A total of 66,304 hospitalizations were reported. The average age was 14.7 weeks; hospitalization events were higher in winter (39%), followed by autumn (27.3%). A total of 371 (0.56%) patients died. A total of 7068 (10.6%) hospitalized patients with pathological histories were identified. The presence of BPD (coefficient = 1.6), CHD (coefficient = 1.2), diagnosis of pneumonia (coefficient = 1.2), in-hospital complications (coefficient = 2.1) and invasive medical procedures (coefficient = 15.7) were the most common factors that increased the length of hospital stay. Risk factors for in-hospital complications and mortality were invasive medical procedure (OR = 3.3 & 11.7), BPD (OR = 1.8 & 1.6), CHD (OR = 4.6 & 3.4) and diagnosis of pneumonia (OR = 1.8 & 4.2). CONCLUSIONS: Risk factors for morbidity and mortality in patients hospitalized for VRIs are BPD and CHD, diagnosis of pneumonia and invasive medical procedure.

Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Type 2 diabetes mellitus (DM2) is a chronic disease, and for treatment to succeed, it is necessary to harmonize the mental health of the patient with the environment, which impacts quality of life and adherence to medical regimens. The objetive of this study is describe the quality of life of patients with DM2 and the factors relates to its modification. METHODS: This investigation was a cross-sectional study. Patients over 18 years of age with DM2 were selected. The following variables related to quality of life were studied: age, sex, occupation, marital status, years of DM2 evolution, comorbidities and presence of depression (Beck Depression Inventory). Perceived quality of life was measured with a health-related quality of life (HRQoL) scale, the 36-Item Short-Form Survey (SF-36). Patients were classified according to SF-36 HRQoL score (< 50, 51-75 and > 76 points). RESULTS: Among the 1394 patients included, the median age was 62 years. Global HRQoL had a median of 50.1 points. Bivariate analysis showed that age, marital status, sex, occupation, comorbidities, duration of DM2 and comorbidities had impacts on HRQoL. The logistic regression model identified age (odds ratio [OR] 1.04) and depression (OR 4.4) as independent factors that influenced overall quality of life. CONCLUSIONS: Patients with DM2 have poor HRQoL, which is associated with a high frequency of depression. Older age and the presence of depression impair patient HRQoL. TRIAL REGISTRATION: R-2013-781-052. Registered 20 December 2014.

Costos medicos directos en pacientes con enfermedad pulmonar obstructiva Crónica en Mexico.

INTRODUCTION: chronic obstructive pulmonary disease (COPD) is a progressive, incurable and potentially mortal. COPD generates a high burden of illness and decreased quality of life in patients. The aim of this study was to determine the direct medical cost of COPD and the primary variables associated. METHODOLOGY: We conducted a multicenter clinical study, based in a retrospective cohort as base of a partial economic evaluation in patients diagnosed with moderate to severe COPD. It was considered an institutional point of view to determine medical costs, with an annual time horizon. For analysis of associations between explanatory and end point variables, a generalized lineal regression model was developed. RESULTS: We analyzed data from 283 patients, Fifty-nine percent were women, the average age was 72 years ± 11, Sixty-five percent of patients had a history of smoking and 57.6 % were exposed to wood smoke. The annual direct medical costs (MXN 2016) was 20,754 and 41,887 for patients with moderate and severe COPD, respectively, this difference is mainly due to the use of oxygen as well as longer hospital stay (12.9 vs. 24.7 days) of patients with severe COPD. CONCLUSIONS: Although the severity level is associated with greater health care costs, the quality of life of the patients should be considered carefully because it is inversely associated with the cost of care for patients with COPD.

Survival rates and worker compensation expenses in a national cohort of Mexican workers with permanent occupational disability caused by diabetes.

BACKGROUND: Permanent occupational disability is one of the most severe consequences of diabetes that impedes the performance of usual working activities among economically active individuals. Survival rates and worker compensation expenses have not previously been examined among Mexican workers. We aimed to describe the worker compensation expenses derived from pension payments and also to examine the survival rates and characteristics associated with all-cause mortality, in a cohort of 34,014 Mexican workers with permanent occupational disability caused by diabetes during the years 2000-2013 at the Mexican Institute of Social Security. METHODS: A cross-sectional analysis study was conducted using national administrative records data from the entire country, regarding permanent occupational disability medical certification, pension payment and vital status. Survival rates were estimated using the Kaplan-Meier method. Multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) in order to assess the cohort characteristics and all-cause mortality risk. Total expenses derived from pension payments for the period were accounted for in U.S. dollars (USD, 2013). RESULTS: There were 12,917 deaths in 142,725.1 person-years. Median survival time was 7.26 years. After multivariate adjusted analysis, males (HR, 1.39; 95 % CI, 1.29-1.50), agricultural, forestry, and fishery workers (HR, 1.41; 95 % CI, 1.15-1.73) and renal complications (HR, 3.49; 95 % CI, 3.18-3.83) had the highest association with all-cause mortality. The all-period expenses derived from pension payments amounted to $777.78 million USD (2013), and showed a sustained increment: from $58.28 million USD in 2000 to $111.62 million USD in 2013 (percentage increase of 91.5 %). CONCLUSIONS: Mexican workers with permanent occupational disability caused by diabetes had a median survival of 7.26 years, and those with renal complications showed the lowest survival in the cohort. Expenses derived from pension payments amounted to $ 777 million USD and showed an important increase from 2000 to 2013.

[Lower extremity amputation rates in diabetic patients]. / Índice de amputaciones de extremidades inferiores en pacientes con diabetes.

BACKGROUND: The lower extremity amputations diminish the quality of life of patients with Diabetes Mellitus (DM). The aim of this study was to describe the lower extremity amputation rates in subjects with DM in the Mexican Social Security Institute (IMSS), comparing 2004 and 2013. METHODS: A comparative cross-sectional study was done. Amputations were identified from the hospital records of System of Medical Statistics (DataMart). The DM patient census was obtained from the System of Integral Attention to Health. Major and minor amputations rates were expressed per 100,000 DM patients. RESULTS: We observed 2 334 340 and 3 416 643 DM patients during 2004 and 2013, respectively. The average age at the time of the amputation was similar in 2004 and 2013 (61.7 and 65.6 years old for minor and major amputations respectively). The major amputations rates were 100.9 and 111.1 per 100 000 subjects with DM in during 2004 and 2013 (p = 0.001); while minor amputations rates were 168.8 and 162.5 per 100 000 subjects with DM in during 2004 and 2013 respectively (p = 0.069). CONCLUSIONS: The lower extremity amputations rates at IMSS are very high compared with that reported in developed countries. The major amputations rate increased in 2013 compared with 2004.

Introducción: las amputaciones de extremidades inferiores disminuyen la calidad de vida de los pacientes con diabetes mellitus (DM). El objetivo de este estudio fue describir el índice de amputaciones de extremidades inferiores (mayores y menores) en sujetos con DM adscritos al Instituto Mexicano del Seguro Social (IMSS), comparando los años 2004 y 2013. Métodos: estudio observacional transversal comparativo. Se evaluaron los registros hospitalarios de amputaciones obtenidos del Sistema de Estadísticas Médicas (DataMart) y del Censo de pacientes con DM obtenido del Sistema de Atención Integral a la Salud. Se calcularon los índices de amputaciones mayores y menores x 100,000 sujetos con DM adscritos a Medicina Familiar. Resultados: durante 2004 y 2013 se observaron 2 334 340 y 3 416 643 pacientes con DM adscritos a Medicina Familiar respectivamente. Los promedios de edad al momento de la amputación fueron similares en el año 2004 y 2013 (61.7 años para las amputaciones menores y 65.6 años para las amputaciones mayores). Los índices de amputaciones mayores fueron de 100.9 y de 111.1 x 100 000 sujetos con DM en 2004 y 2013; mientras que el índice de amputaciones menores de extremidades inferiores fue de 168.8 y de 162.5 x 100 000 sujetos con DM en el durante 2004 y 2013 respectivamente. Conclusiones: el índice de amputaciones de extremidades inferiores en el IMSS es muy alto comparado con lo reportado en países desarrollados. El índice de amputaciones mayores se incrementó para el año 2013, comparado con 2004.

Oral antithrombotic use among myocardial infarction patients.

OBJECTIVE: To examine the use of oral antithrombotics (i.e., antiplatelet agents, oral anticoagulants) after myocardial infarction (MI) in the Netherlands from 1988 to 1998. METHODS: Retrospective follow-up of 3800 patients with MI, using data from the PHARMO Record Linkage System. RESULTS: From 1988 to 1998, oral antithrombotic treatment increased significantly from 54.0% to 88.9%. In 1998, only 75.8% of patients who experienced a MI in the late 1980s received oral antithrombotic treatment compared with 94.4% of those who experienced a recent MI. CONCLUSIONS: Oral antithrombotics were considerably underused in patients with a past history of MI. Therefore, these patients should be reviewed for antithrombotic therapy to assess whether their failure to use oral antithrombotics was right or wrong, and whether treatment should be initiated if possible.

Efecto del extracto de Staphylococcus aureus en la expresión de L-selectina y LFA-1, en neutrófilos de pacientes con asma bronquial no alérgica / L-selectin and LFA-1 in neutrophils from moderate and non atopic asthma patients, before and after stimuli with and without Staphylococcus aureus

Objetivo. Comparar el número de neutrófilos que expresan en su superficie la molécula L-selectina y LFA-1, obtenidos de pacientes con asma bronquial moderada no alérgica, con y sin estímulo con extracto de Sa(Staphylococcus aureus). Material y método. Estudio experimental. Se estudiaron neutrófilos de 12 pacientes con asma bronquial moderada no alérgica y 12 sujetos controles sanos con y sin estímulo de Sa. Mediciones: se determinaron las moléculas de adhesión Cd 62-L y el CD 11 a mediante citometria de flujo expresadas en la superficie de neutrófilos. Resultados. La mediana de la expresión de la molécula Cd 62L aumentó con el estímulo del extracto bacteriano, en pacientes asmáticos de 2444 (Cl 1966, CS 3627, RC 1661) a 6285.5 (Cl 5243, CS 7203, RC 1960) y la mediana de la expresión de la molécula CD 1 la disminuyó con el estímulo del extracto bacteriano, en pacientes asmáticos 9910.5 (Cl 9765, CS 9961, RC 196) a 7670 (Cl 7125, CS 8291, RC 1166). La mediana de la expresión de la molécula CD 62L aumentó con el estímulo del extracto bacteriano, en sujetos sanos de 593 (Cl 361, CS 929, RC 568) a 1113 (a910, CS 1240, RC 330) y la mediana de la expresión de la molécula CD 11a disminuyó con el estímulo del extracto bacteriano, en sujetos sanos de 9850 (Cl 9741, CS 9898, RC 157) a 9808.5 (CL 9693, CS 9890, RC 197) [CL. Cuartil inferior, CS. Cuartil superior, RC. Rango cuartilar]

In vitro effect of complete Staphylococcus aureus extract on chemotaxis of polymorphonuclear cells in children with bronchial asthma and chronic relapsing upper airways infections

Se midieron la quimiocinesis y quimiotaxis en células polimorfonucleares (PMN) obtenidas de 51 niños de 1 a 8 años de edad, de uno y otro sexo. Grupo de casos: 41 niños con asma no alérgica e infecciones crónicas recurrentes de las vías aéreas superiores; los criterios diagnósticos fueron antecedentes de sibilancias relacionadas con un episodio de infección de las vías aéreas superiores y pruebas cutáneas negativas. Grupo testigo: 10 niños sanos. Se obtuvo una muestra de 10 ml de sangre venosa periférica. Los PMN se incubaron con solución de Hank para medir la quimiocinesis y con C5a y extracto de Staphylococcus aureus para medir quimiotaxis. Los valores de quimiocinesis en los niños sanos testigos y en los pacientes con asma bronquial no alérgica fueron de 46.0 ñ 7.1 vs 23.8 ñ 6.1 µm (p < 0.01). Los valores de quimiotaxis estimulada con C5a en los niños sanos testigos y en los pacientes con asma bronquial no alérgica fueron de 91.0 ñ 21.3 vs 92.3 ñ 21.0 µm (ns), y los valores de quimiotaxis estimulada con extracto de Staphylococcus aureus fueron de 97.0 ñ 22.4 vs 92.0 ñ 23.0 µm (ns). Estos resultados sugieren que los PMN de niños con asma no atópica tienen quimiocinesis reducida. Después de un estímulo quimiotáctico con C5a y extracto bacteriano, la movilidad de los leucocitos se corige y alcanza valores similares a los coexistentes en niños sanos

Actividad fagocítica de polimorfonucleares en pacientes con hipersensibilidad a la aspirina, asma y pólipos nasales / Phagocytic function in patients with aspirine sensitive asthma and hypertrophy rhinosinusitis with nasal polyps

La eficiencia de la función fagocítica depende de la óptima actividad de cada estadio del proceso fagocítico. Los pacientes con hipersensibilidad a la aspirina, asma, rinosinusitis hipertrófica con pólipos nasales ®triada de la aspirina¼ (pacientes ASA) tienen indicios de defectos en la fagocitosis. Se estudiaron 34 pacientes ASA y 34 sujetos sanos. Las células polimorfonucleares, quimioluminiscencia (CL) de los pacientes ASA se estudiaron in vitro. La actividad fagocítica se midió con la técnica de quimioluminiscencia. No se encontraron diferencias estadísticas con la prueba de U de Mann Whitney (p=NS). No hubo diferencias en la capacidad fagocítica de polimorfonucleares de pacientes ASA y controles sanos. A pesar de los avances de las ciencias básicas, la causa y patogenesis de los pólipos nasales no se ha aclarado, particularmente la tinosinusitis, asma intrínseca y la intolerancia a farmacos no esteroides

Eosinofilia nasal posterior al reto específico en pacientes con rinitis alérgica perenne / Nasal eosinophilia after the perenial allergic rinithis

Se estudió a 35 pacientes con respuesta alérgica perenne para conocer la eosinofilia después del reto nasal con antigeno especifíco. Los pacientes se seleccionaron al azar. A todos se les realizó historia clínica, pruebas cutáneas y cuantificación de eosinófilos en la mucosa nasal a la media hora y a las ocho horas después del reto con alergeno de Dermatophagoides. Los resultados mostraron aumento significativo de eosinófilos después del reto (p.006). No se observaron diferencias significativas en el número de eosinófilos a la media hora y a las ocho horas después del reto

Inmunología de la relación materno fetal / Immune responses during pregnancy

Desde hace 40 años se consideraba que durante el embarazo los antígenos fetales se expresan de forma diferente a cualquier injerto; los datos actuales indican que la aceptación del feto por la madre depende de la falta de expresión de antígenos polimórficos, además de la producción de hormonas que actúan como inmunosupresoras. Durante el embarazo hay reconocimiento inmunológico de antígenos del trofoblasto; estos antígenos expresados por el trofoblasto no son polimórficos y previenen el reconocimiento de células T citotóxicas y células NK; además, esta estructura produce hormonas que también contribuyen a la disminución en la producción y proliferación de células T. Se ha demostrado que existe aumento en la producción de inhibidores del complemento de parte del trofoblasto (DAF, CD46) así como aumento en la secreción de hormonas como la progesterona, alfafetoproteína, esteroides y prostaglandinas. La identificación de estos factores y mecanismos inmunológicos puede ser fundamental en la búsqueda de tratamiento para padecimiento como cáncer, abortos espontáneos, infertilidad y trasplantes

Efecto en el VEF1 al administrar salbutamol con la cámara de retención, espaciador e inhalador de dosis medida / The VEF1 effect at the salbutamol administration with the retention camera, inhalator of control dosage

Se incluyeron 13 pacientes con diagnóstico de asma y que cumplían con los criterios de selección, a los cuales se les practicó espirometría antes y después de aplicar salbutamol por alguno de los dispositivos en forma aleatoria. El efecto sobre el VEF1 con el inhalador de dosis medida (MDI) fue de 22.76 por ciento, con el espaciador fue 23.35 por ciento y con la cámara de retención 23.94 por ciento. El análisis estadístico no mostró diferencia significativa entre los resultados, por lo que se refiere que los tres dispositivos tienen la misma eficacia para administrar salbutamol en aerosol

Efecto in vitro del extracto bacteriano de S. aureus en la quimiocinesis y quimiotaxis de células polimorfonucleares / Effect the extract of Staphylococcus aureus in vitro can modify chemokinesis and induce chemotaxis of polimorphonuclear cells

El propósito del trabajo fue determinar si el extracto de Staphylococcus aureus in vitro puede modificar la quimiocinesis e inducir la quimiotaxis de las células polimorfonucleares de la sangre periférica en donadores sanos. Se determinó la quimiocinesis y la quimiotaxis de los polimorfonucleares de la sangre periférica de 30 donadores sanos de uno y otro sexo con un límite de edad entre 18 y 40 años. Se les extrajeron 5 mL de sangre periférica separando los polimorfonucleares por el método de Boyum y se retaron con extracto de Staphylococcus aureus y C5a como quimiotácticos, y solución de Hank para medir quimiocinesis. Esta tuvo un promedio de 54.6ñ8.8 µm, la respuesta quimiotáctica a C5a fue 89ñ12.5 µm y con el extracto bacteriano fue 103ñ20.1 µm (p<0.001. Análisis estadístico: prueba de Wilcoxon. Se concluye que el extracto completo de Staphylococcus aureus estímula in vitro la quimiotaxis de polimorfonucleares de donadores sanos y que esta estimulación es comparable con lo quimioatrayentes conocidos como C5a

Efecto in vitro de la tuftsina (L-prolil-L-arginina) en la capacidad oxidativa de los polimorfonucleares en niños recién nacidos pequeños para su edad gestacional / Tuftsin (L-prolil-L-arginina) has the function of activating cellular macrophages and polymorphonucleras in newborns

Se comunican los resultados de un trabajo realizado para determinar el efecto de la tuftsina sintética en la capacidad oxidativa de células polimorfonucleares de niños recién nacidos pequeños para su edad gestacional, ya que se ha demostrado que está disminuida la actividad fagocítica de macrófagos y polimorfonucleares (PMNs) comparada con las células de niños con peso adecuado para su edad gestacional. En los resultados se observó un efecto de estimulación de la capacidad oxidativa de los PMNs con tuftsina sintética a través de incrementar la reducción de nitroazul de tetrazolio, lo que sugiere que la baja capacidad oxidativa de las células de recién nacidos pequeños para su edad gestacional no se relaciona con un defecto intrínseco celular

Características clínicas y de laboratorio de 100 pacientes con rinitis alérgica perenne / Laboratory and clinical characteristics of 100 patients with perennial allergic rhinitis

Se estudiaron los expedientes clínicos de 100 pacientes con diagnóstico clínico de rinitis alérgica perenne; fueron 66 mujeres y 34 varones, con una media de 28.6 años. Las pruebas cutáneas resultaron positivas a pólenes en 78 por ciento de los casos, hongos 39 por ciento, inhalables 39 por ciento, dermatofagoides 19 por ciento y bacteriana 7 por ciento. En el cultivo del moco nasal se aislaron los siguientes gérmenes: S epidermis 49 por ciento, S aureus 25 por ciento, Neisseria sp 15 por ciento, Corynebacterium 2 por ciento, P mirabilis 1 por ciento y E coli 1 por ciento. La citología nasal mostró positividad en 25 por ciento de los casos para la presencia de eosinófilos, y negatividad en 75 por ciento. En sólo 27 por ciento de los pacientes se encontró eosinofilia en sangre periférica. Se comentan los resultados y se discute la utilidad del cultivo de moco nasal y de la citología de moco nasal en lospacientes con rinitis alérgica perenne