Cost-effectiveness models for Alzheimer's disease and related dementias: IPECAD modeling workshop cross-comparison challenge.

INTRODUCTION: The credibility of model-based economic evaluations of Alzheimer's disease (AD) interventions is central to appropriate decision-making in a policy context. We report on the International PharmacoEconomic Collaboration on Alzheimer's Disease (IPECAD) Modeling Workshop Challenge. METHODS: Two common benchmark scenarios, for the hypothetical treatment of AD mild cognitive impairment (MCI) and mild dementia, were developed jointly by 29 participants. Model outcomes were summarized, and cross-comparisons were discussed during a structured workshop. RESULTS: A broad concordance was established among participants. Mean 10-year restricted survival and time in MCI in the control group ranged across 10 MCI models from 6.7 to 9.5 years and 3.4 to 5.6 years, respectively; and across 4 mild dementia models from 5.4 to 7.9 years (survival) and 1.5 to 4.2 years (mild dementia). DISCUSSION: The model comparison increased our understanding of methods, data used, and disease progression. We established a collaboration framework to assess cost-effectiveness outcomes, an important step toward transparent and credible AD models.

Real-Time Genomic Surveillance for SARS-CoV-2 Variants of Concern, Uruguay.

We developed a genomic surveillance program for real-time monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) in Uruguay. We report on a PCR method for SARS-CoV-2 VOCs, the surveillance workflow, and multiple independent introductions and community transmission of the SARS-CoV-2 P.1 VOC in Uruguay.

Effect of a nitrogenous nanocomposite on leaching and N content in lettuce in soil columns.

Nanofertilizers could promote nutrient efficiency with slow release compared to conventional fertilizers (CF). Most of the applied nitrogen is lost on the soil by leaching, due to the rapid release behavior of CF. Clays can function as a nanosized porous structure to retain and slowly release nutrients. The objective of this study was to evaluate a nitrogenous nanocomposite (NCN) and its effect on leaching and N content of lettuce (Lactuca sativa). The treatments applied were: 100% conventional fertilizer, 100% nitrogenous nanocomposite and the mixture in percentage of CF/NCN 25/75, 50/50, 75/25 and 25/0, 50/0 75/0% on columns of soil with lettuce for 45 days. Leachates at the end of the cycle increased in treatments with NCN. Treatments with NCN have higher N content in the leaf. In regard to biomass growth, leaf area, leaf N, drained variables, electrical conductivity and NO3- content, it was possible to show that the doses of 50 and 75% of NCN match the characteristics of the crop compared to the control, which allows us to use lower doses than those recommended with CFs.

Effectiveness of Tranexamic Acid in the Postoperative Period in Body Contour Surgery: Randomized Clinical Trial.

Background: Tranexamic acid (TXA) is used to reduce bleeding in body contouring procedures; however, there are no studies that show the effectiveness of TXA when it is also used in the immediate postoperative period. Methods: A controlled, randomized, parallel, and open-label clinical trial was carried out in adult patients undergoing liposculpture and/or abdominoplasty. A control group administering presurgical TXA and a study group with presurgical and postsurgical TXA were formed. The decrease in hemoglobin and the incidence of blood transfusions between both groups were compared as well as the possible adverse effects of TXA. Results: Four hundred twenty-seven subjects were included, 208 (48.7%) in the control group and 219 (51.3%) in the study group. The median age was 34 years (interquartile range 28-42). Median postoperative hemoglobin levels at 24 hours were similar in both groups (study 11.3 g/dL versus control 11.1 g/dL, P = 0.07); however, at 72 hours, postoperative hemoglobin was higher in the study group versus control (10.8 versus 10.0 g/dL, P ≤ 0.001). The incidence of transfusions at 72 hours was 1.8% in the study group and 8.6% in the control group, for a risk ratio of 0.21 (95% confidence interval 0.07-0.61). There were no adverse or thromboembolic events. Conclusion: TXA proved to be more effective in reducing intra- and postsurgical bleeding and the need for transfusions, when used preoperatively and continued for 48 hours after surgery, than when used only preoperatively, without reporting adverse or thromboembolic effects.

Age-specific rates of onset of cannabis use in Mexico.

BACKGROUND: Over the previous two decades, the lifetime prevalence of cannabis use has risen among Mexico's population. AIMS: Estimate the sex- and age-specific rates of onset of cannabis use over time. DESIGN: Five nationally representative cross-sectional surveys, the Mexican National Surveys of Addictions (1998, 2002, 2008, 2012) and the Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (2016). SETTING: Mexico. PARTICIPANTS: Pooled sample of 141,342 respondents aged between 12 and 65 years of which 43.6%(n = 61,658) are male and 56.4% (n = 79,684) are female. MEASUREMENTS: We estimated the age-specific rates of onset of cannabis as the conditional rate of consuming cannabis for the first time at a specific age. METHODS: Time-to-event flexible-parametric models with spline specifications of the hazard function. Stratified analysis by sex and control for temporal trends by year of data collection or decennial birth cohort. FINDINGS: Age-specific rates of onset of cannabis use per 1,000 individuals increased over time for females and males. Peak rates of onset of cannabis use per 1,000 ranged from 0.935 (95%CI = [0.772, 1.148]) in 1998, to 5.391 (95%CI = [4.924, 5.971]) in 2016 for females; and from 7.513 (95%CI = [6.732, 10.063]) in 1998, to 26.107 (95%CI = [25.918,30.654]) in 2016 for males. Across decennial birth-cohorts, peak rates of onset of cannabis use per 1,000 individuals for females ranged from 0.234 (95%CI = [0.078, 0.768]) for those born in the 1930s, to 14.611 (95%CI = [13.243, 16.102]) for those born in the 1990s; and for males, from 4.086 (95%CI = [4.022, 7.857]) for those born in the 1930s, to 38.693 (95%CI = [24.847, 48.670]) for those born in the 1990s. CONCLUSION: Rates of onset of cannabis increased over the previous two decades for both females and males but remained higher for males. Across recent cohorts, the rates of onset have increased at a faster rate among females than males.

Assessing deep learning methods for the identification of kidney stones in endoscopic images.

Knowing the type (i.e., the biochemical composition) of kidney stones is crucial to prevent relapses with an appropriate treatment. During ureteroscopies, kidney stones are fragmented, extracted from the urinary tract, and their composition is determined using a morpho-constitutional analysis. This procedure is time-consuming (the morpho-constitutional analysis results are only available after several weeks) and tedious (the fragment extraction lasts up to an hour). Identifying the kidney stone type only with the in-vivo endoscopic images would allow for the dusting of the fragments and eneable early treatments, while the morpho-constitutional analysis is ready. Only few contributions dealing with the in vivo identification of kidney stones have been published. This paper discusses and compares five classification methods including deep convolutional neural networks (DCNN)-based approaches and traditional (non DCNN-based) ones. Even if the best method is a DCCN approach with a precision and recall of 98% and 97% over four classes, this contribution shows that an XGBoost classifier exploiting well-chosen feature vectors can closely approach the performances of DCNN classifiers for a medical application with a limited number of annotated data.

Patient Blood Management Strategies to Avoid Transfusions in Body Contouring Operations: Controlled Clinical Trial.

BACKGROUND: Anemia is a frequent process of morbidity and mortality in body contouring procedures. In aesthetic surgery, there are no standardized processes to minimize bleeding during surgery. For this reason, a study was designed to implement patient blood management strategies to reduce bleeding and transfusions in patients undergoing body contouring operations. METHODS: From January of 2017 to May of 2018, a prospective cohort-type observational study was conducted, including two groups of patients undergoing single or combined body contouring procedures. The first group did not receive patient blood management strategies, whereas the second group did receive these strategies. These measures consisted of preoperative strategies to ensure the patient had optimal hemoglobin and hematocrit levels and supportive intraoperative measures to minimize blood loss. The results were validated with different statistical tests according to the variables studied. RESULTS: A total of 409 patients were included in the study and were divided into two groups. The anthropometric and hemoglobin variables were similar in both groups. The 207 patients for whom patient blood management strategies were implemented lost an average of 1.2 g/dl less hemoglobin at 72 hours than the 202 patients for whom patient blood management strategies were not implemented (p ≤ 0.0001). CONCLUSIONS: Patient blood management strategies, such as increasing hemoglobin before surgery, and strategies to minimize blood loss during surgery, proved to be effective at reducing bleeding in patients undergoing body contouring surgery, also decreasing the need to perform postoperative blood transfusions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Emergence and Spread of a B.1.1.28-Derived P.6 Lineage with Q675H and Q677H Spike Mutations in Uruguay.

Uruguay controlled the viral dissemination during the first nine months of the SARS-CoV-2 pandemic. Unfortunately, towards the end of 2020, the number of daily new cases exponentially increased. Herein, we analyzed the country-wide genetic diversity of SARS-CoV-2 between November 2020 and April 2021. We identified that the most prevalent viral variant during the first epidemic wave in Uruguay (December 2020-February 2021) was a B.1.1.28 sublineage carrying Spike mutations Q675H + Q677H, now designated as P.6, followed by lineages P.2 and P.7. P.6 probably arose around November 2020, in Montevideo, Uruguay's capital department, and rapidly spread to other departments, with evidence of further local transmission clusters; it also spread sporadically to the USA and Spain. The more efficient dissemination of lineage P.6 with respect to P.2 and P.7 and the presence of mutations (Q675H and Q677H) in the proximity of the key cleavage site at the S1/S2 boundary suggest that P.6 may be more transmissible than other lineages co-circulating in Uruguay. Although P.6 was replaced by the variant of concern (VOC) P.1 as the predominant lineage in Uruguay since April 2021, the monitoring of the concurrent emergence of Q675H + Q677H in VOCs should be of worldwide interest.

A Policy Analysis on the Proactive Prevention of Chronic Disease: Learnings from the Initial Implementation of Integrated Measurement for Early Detection (MIDO).

Mexico, like many low- and middle-income countries (LMICs), faces an epidemic of chronic non-communicable diseases (NCDs), specifically diabetes, hypertension, obesity, and lipid disorders. Many people with these NCDs may not be aware that they have a disease, pointing to the need for broader screening programs. The traditional prevention policy in Mexico was based on screening with a paper-based risk factor questionnaire. However, this was used to screen patients already seeking healthcare services at facilities, and screening goals were set as a function of the number of questionnaires applied, not number of individuals screened. Due to this, Fundación Carlos Slim developed Medición Integrada para la Detección Oportuna (MIDOTM), or Integrated Measurement for Early Detection, an NCD screening and proactive prevention policy. This document is a policy analysis based on early learnings from the initial implementation of MIDO in eight primary healthcare centers in two central Mexican states. MIDO was found to expand screening programs beyond clinic walls, systematize community screening strategies, emphasize the detection of pre-disease phases, incorporate lifestyle counseling, and propose screening goals based on population targets. In collaboration with the Mexican Ministry of Health, MIDO has successfully screened over 500 000 individuals-about 40% of whom would not have been screened under previous policies. Of these more than 500 000 screened individuals, 13.4% had pre-diabetes (fasting glucose between 100 and 125 mg/dL), and 5.8% had undiagnosed diabetes (defined as fasting glucose above 126 mg/dL or random glucose above 200 mg/dL). However, there is still room for improvement in linking positive results from screening with disease confirmation and with patient incorporation into disease management. The experience of implementing MIDO in Mexico suggests that primary and secondary prevention programs in other parts of the world should consider the need for population-based screening targets, a greater focus on pre-disease stages, and the streamlining of the transition between screening, confirmation of diagnosis, and incorporation of patients into the healthcare system.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Resistencia bacteriana en urocultivos de una población de embarazadas de control prenatal en Bogotá junio 2013­junio 2015 / Bacterial resistance in urine cultures ina population of pregnant women in prenatal care in bogota june2013 ­june 2015

La infección urinaria baja, específicamente la bacteriuria asintomática afecta el 2 al 7% de los embarazos; sin tratamiento, evoluciona a pielonefritis, aumentala probabilidad de parto pretérmino, bajo peso al nacer y preeclampsia. La identificación y tratamiento de la infección urinaria bajaes prioritaria.Conocer la sensibilidad antibiótica de los diferentes patógenos permiterevisar las estrategias de tratamiento y disminuir los desenlaces adversos perinatales.Objetivo:Determinar el perfil de resistencia de los principales patógenos aislados en los urocultivos de las pacientes embarazadas que acudieron a control prenatal en Clínica Colsanitas. Materiales y Métodos:Se realizó un estudio observacional con pacientes gestantes que asistieron a control prenatal. Se tomaron todos los resultados de urocultivos de las pacientes gestantes y se excluyeron urocultivos sugestivos de contaminación. Se analizaron los patógenos aislados y la sensibilidad a los diferentes antibióticos. Resultados:De 14054 muestras para urocultivo 1177 resultaron positivas.El principal patógeno aislado fue Escherichia colicon una prevalencia del 71,4%, seguido en frecuencia por Enterococcus faecalis, Proteus mirabilis y Klebsiella pneumoniae. La resistenciade Escherichia colia ampicilina fue de 37,3%, atrimetoprim sulfametoxazol 23,3%, cefalotina 11,1%.Lasensibilidad afosfomicina fue de 98%. En general los patógenos más frecuentemente aislados presentaron bajas tasas de expresión de betalactamasas. Conclusiones:E. colifue el patógeno más frecuente.La alta resistencia a la ampicilinacontraindica su uso empírico.El uso de otros antibióticos como cefalexina o nitrofurantoínaes adecuado.Fosfomicina puede ser una opción cuando no sea posible usar los anteriormente descritos.

Urinary tract infection(UTI), specifically asymptomatic bacteriuria, affects 2% to 7% of pregnancies; without treatment, it evolves into pyelonephritis, increases the probability of preterm birth, low birth weight and preeclampsia.Detection and treatment of UTIis a priority. Knowing the antibiotic sensitivity of different pathogens allows us to review treatment strategies and reduce adverse perinatal outcomes.Objective: To determine the resistance profile of the main pathogens isolated in urine cultures of pregnant patients who attended prenatal care in Clinica Colsanitas. Materials and Methods: An observational study was performed with pregnant patients who attended prenatal care. All urine culture results were taken from the pregnant patients and urine cultures suggestive of contamination were excluded. The isolated pathogens and the sensitivity to the different antibiotics were analyzed.Results: Out of 14054 urine samples, 1177 were positive. The main isolated pathogen was Escherichia coli with a prevalence of 71.4%, followed in frequencyby Enterococcus faecalis, Proteus mirabilis and Klebsiella pneumoniae. The resistance of Escherichia coli to ampicillin was 37.3%, trimethoprimsulfamethoxazole 23.3%, cefalotin 11.1%. The sensitivity to fosfomycin was 98%. In general, the most frequently isolated pathogens showed low rates of beta-lactamase expression.Conclusions:E. coli was the most frequent pathogen. The high resistance to ampicillin contraindicates its empirical use. The use of other antibiotics such as cephalexin or nitrofurantoin is adequate. Fosfomycin may be an option when it is not possible to use previously described.