[Excessive spending by misuse of clinical laboratory]. / Gasto excesivo por uso inadecuado del laboratorio clínico.

Seventy five percent or more of a diagnosis comes from a proper medical history along with an excellent physical examination. This leaves to the clinical laboratory the function of supporting the findings, determining prognosis, classifying the diseases, monitoring the diseases and, in the minimum of cases, establishing the diagnosis. In recent years there has been a global phenomenon in which the allocation of resources to health care has grown in an excessive way; the Instituto Mexicano del Seguro Social is not an exception with an increase of 29 % from 2009 to 2011; therefore, it is necessary to set containment and reduction without compromising the quality of patient care.

El 75 % o más del diagnóstico de una entidad nosológica proviene de una adecuada historia clínica junto con una exhaustiva exploración física, lo cual le deja al laboratorio clínico la función de apoyar los hallazgos, establecer pronóstico, clasificar una enfermedad, dar seguimiento y establecer en el mínimo de los casos un diagnóstico. En los últimos años se ha presentado un fenómeno global en el que la erogación de recursos para la atención a la salud ha aumentado de forma desmedida y el Instituto Mexicano del Seguro Social no ha sido la excepción con un aumento del 29 % del 2009 al 2011, por lo que es necesario el establecimiento de medidas de contención y reducción sin que se comprometa la calidad de la atención a los pacientes.

Cost-Effectiveness of Blood Donation Screening for Trypanosoma cruzi in Mexico.

An estimated 2 million inhabitants are infected with Chagas disease in Mexico, with highest prevalence coinciding with highest demographic density in the southern half of the country. After vector-borne transmission, Trypanosoma cruzi is principally transmitted to humans via blood transfusion. Despite initiation of serological screening of blood donations or donors for T. cruzi since 1990 in most Latin American countries, Mexico only finally included mandatory serological screening nationwide in official Norms in 2012. Most recent regulatory changes and segmented blood services in Mexico may affect compliance of mandatory screening guidelines. The objective of this study was to calculate the incremental cost-effectiveness ratio for total compliance of current guidelines from both Mexican primary healthcare and regular salaried worker health service institutions: the Secretary of Health and the Mexican Institute for Social Security. We developed a bi-modular model to analyze compliance using a decision tree for the most common screening algorithms for each health institution, and a Markov transition model for the natural history of illness and care. The incremental cost effectiveness ratio based on life-years gained is US$ 383 for the Secretary of Health, while the cost for an additional life-year gained is US$ 463 for the Social Security Institute. The results of the present study suggest that due to incomplete compliance of Mexico's national legislation during 2013 and 2014, the MoH has failed to confirm 15,162 T. cruzi infections, has not prevented 2,347 avoidable infections, and has lost 333,483 life-years. Although there is a vast difference in T. cruzi prevalence between Bolivia and Mexico, Bolivia established mandatory blood screening for T.cruzi in 1996 and until 2002 detected and discarded 11,489 T. cruzi -infected blood units and prevented 2,879 potential infections with their transfusion blood screening program. In the first two years of Mexico's mandated program, the two primary institutions failed to prevent due to incomplete compliance more potential infections than those gained from the first five years of Bolivia's program. Full regulatory compliance should be clearly understood as mandatory for the sake of blood security, and its monitoring and analysis in Mexico should be part of the health authority's responsibility.

Cord blood banking and transplantation at the Mexican Institute of Social Security: the first 5 years.

BACKGROUND: In January 2005, the Cord Blood Bank (CBB) at the Mexican Institute of Social Security initiated activities. Herein, we describe the experience generated during this period (January 1, 2005-December 31, 2009). STUDY DESIGN AND METHODS: Good manufacturing practices and standard operating procedures were used to address donor selection, as well as umbilical cord blood (UCB) collection, processing, and cryopreservation. Based mainly on HLA and nucleated cell content, specific UCB units were thawed, processed, and released for transplantation. RESULTS: A total of 589 UCB units were stored, representing 54% of the total number of units collected. Forty-eight units (8.14% of the stored units) were released for transplantation of 36 patients. Twenty-six patients (72% of cases) corresponded to patients with acute leukemia, five (14%) to patients with marrow failure, and the rest (five; 14%) to patients with hemoglobinopathies and other syndromes. The median number of nucleated cells infused per patient was 6.71 × 10(7) /kg and the median number of CD34+ cells was 4.8 × 10(5) /kg. Current engraftment data indicate that engraftment occurred in 56%, and no engraftment in 44%, of cases. Engraftment was more frequent (59%) in patients that received more than 3 × 10(7) total nucleated cells (TNCs)/kg body weight, than in those receiving fewer than 3 × 10(7) TNCs/kg (40%). Myeloid engraftment was observed 7 to 54 days posttransplant (median, 23 days), whereas platelet engraftment was detected on Days 12 to 87 posttransplant (median, 38 days). To date, the disease-free survival rate was 41% and the overall survival was 47%, with survival periods of 126 to 1654 days. CONCLUSION: Although the experience presented herein is still limited and the period of analysis is still short, the results obtained during these 5 years are encouraging.

[Detection of Trypanosoma cruzi in blood donors]. / Detección de Tripanosoma cruzi en donadores de sangre.

BACKGROUND: The American trypanosomiasis is the second parasitic disease in importance after paludism and one of the main mechanism of transmission is a blood transfusion. Our objective was to measure the effect the Tripanosoma Cruzi screening test in blood banks in the Mexican Institute of Social Security. METHODS: Information was obtained from each unit of blood collected. The Tripanosoma cruzi prevalence was calculated only in samples with double reactivity in the blood banks. RESULTS: Of 71 blood banks, only 26 had been doing T. Cruzi screen; after implementation of integrated services 55 are doing the screening. There were 935 donors with double reactivity to the T. Cruzi test from 230,074 samples. The national prevalence was 0.406%. The seroprevalence was 0.013% to 3.118%. CONCLUSIONS: The screening of the T. cruzi improved the detection and increased the safety and the prevention of its transmission by blood transfusion.

Establishing a cord blood banking and transplantation program in Mexico: a single institution experience.

BACKGROUND: Over the past decade, umbilical cord blood (UCB) banking and transplantation have increased significantly worldwide. The experience in developing countries, however, is still limited. In January 2005 the Mexican Institute of Social Security (IMSS) initiated its UCB banking and transplantation program. This study reports on the experience generated at this institution during the first 2 years of activities. STUDY DESIGN AND METHODS: A public UCB bank was established at La Raza Medical Center, IMSS, in Mexico City. Good manufacturing practices and standard operating procedures were used to address donor selection, as well as UCB collection, processing, and cryopreservation. Based mainly on human leukocyte antigen (HLA) and total nucleated cell (TNC) content, specific UCB units were thawed, processed, and released for transplantation. RESULTS: Based on stringent selection criteria, 360 UCB units were collected from January 2005 to December 2006. A total of 201 (56%) units (minimum volume, 50 mL without anticoagulant) were processed and stored. Median values for specific parameters were as follows: volume, 89.9 mL; viability, 94.8%; TNCs, 0.91 x 10(9); CD34+ cells, 3.13 x 10(6); and colony-forming cells, 1.20 x 10(6). During this period, 10 units had been released for transplantation to seven patients (six children and one adult). Engraftment was observed in five patients; four of them were still in remission (114-293 days after transplant). In spite of showing sustained engraftment, one patient died on Day +88. Two patients showed no engraftment and died 29 to 30 days after transplant. CONCLUSION: The results obtained during this initial period are encouraging and indicate that the UCB banking and transplantation program at IMSS will help to improve already existing hematopoietic cell transplant programs in Mexico. The experience generated at IMSS may be helpful to other institutions, particularly those in developing countries.