Cost-effectiveness analysis of dupilumab versus omalizumab, mepolizumab, and benralizumab added to the standard of care in adults with severe asthma in Colombia.

BACKGROUND: Cost-effectiveness studies evaluate health technologies and help choose treatments. The current study compared dupilumab to omalizumab, mepolizumab, and benralizumab in Colombian adults with severe uncontrolled type 2 asthma. METHODS: Over a 5-year period, a Markov model was utilized to assess the costs of biological treatments and management of exacerbations, comparing various doses of exacerbations, comparing various doses of dupilumab, omalizumab, mepolizumab, and benralizumab as add-on treatments. It included a 5% annual discount rate per local HTA, and set willingness-to-pay at three times GDP per capita per quality-adjusted life year (QALY) in Colombia. RESULTS: Dupilumab (200 mg) exhibited greater QALYs and reduced overall costs compared to mepolizumab (100 mg), benralizumab (30 mg), and omalizumab (450 mg and 600 mg), with the incremental cost-effectiveness ratio (ICER) per QALYgained being -$5.429, -$6.269, -$196.567 and -$991.007, respectively. Dupilumab had greater QALYs and costs versus omalizumab 300 mg (ICERof $200.653 per QALY, above the willingness-to-pay threshold of 3 × GDP per capita). Sensitivity analyses were consistent with base case results. CONCLUSIONS: Dupilumab 200 mg was strongly dominant versus omalizumab 450 mg and 600 mg, mepolizumab 100 mg, and benralizumab 30 mg; however, cost-effectiveness was not demonstrated versus omalizumab 300 mg. These results could assist healthcare professionals in choosing an appropriate biologic for treating severe type 2 asthma.

Effectiveness and safety of dupilumab in adults with moderate and severe atopic dermatitis in Colombia: Real-life experience.

Background: Dupilumab is a treatment approved for uncontrolled moderate-to-severe atopic dermatitis (AD). Tropical and developing countries such as Colombia have characteristics that may impact the natural history of AD and access to medical treatments. In that sense, we aimed to describe the effectiveness and safety of dupilumab in adults with moderate to severe AD in a Colombian multicenter cohort. Methods: Multicenter descriptive study that included patients who started treatment between March 2018 and May 2020 in 6 centers. Disease severity was assessed using the following: Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Patient Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI). These measurements were collected according to availability at baseline, 3-5 months, 6-12 months, and more than 12 months. Days of sick leave, hospitalizations, and AD flares before and after dupilumab treatment were reported. Adverse events (AEs) were recorded during follow-up. Results: Ninety-three patients were included, with a median age of 32 years (IQR: 24.0; 40.0) and a disease evolution time of 21 years (IQR: 16.0; 29.5). 88.2% had at least 1 allergic disease other than AD. An improvement greater than or equal to 75% EASI was observed in 41.7% of patients at 3-5 months, in 73.7% of patients at 6-12 months, and in 75.0% of patients after 12 months. For those reporting SCORAD and POEM, the median percent change ([IQR], n) from baseline in SCORAD was -67.1 ([-79.2; -54.2], n = 16), -70.5 ([-85.8; -47.9], n = 36) and -66.7 ([-77.3; -51.0], n = 13); and POEM, -58.6 ([-66.4; -55.5], n = 4), -73.0 ([-86.5; -66.7], n = 16) and -87.3 ([-93.4; -69.6], n = 8), respectively. Before initiation of dupilumab treatment, 82 (88.2%) patients reported at least 1 flare of AD in the past 12 months. During the follow-up period, 30 (32.3%) patients reported at least 1 exacerbation or flare. Twelve patients (12.9%) presented an AE and 3 (3.2%) patients discontinued dupilumab for this cause. Conclusions: Dupilumab was effective and safe for the treatment of moderate to severe AD in point-of-care settings, with results similar to randomized controlled and other real-life studies. These positive results are still maintained even though a high number of patients had short interruptions in the use of dupilumab due to administrative problems.

Cycad phylogeny predicts host plant use of Eumaeus butterflies.

Eumaeus butterflies are obligate herbivores of Zamia, the most diverse neotropical genus of cycads. Eumaeus-Zamia interactions have been characterized mainly for species distributed in North and Central America. However, larval host plant use by the southern Eumaeus clade remains largely unknown, precluding a comprehensive study of co-evolution between the genera. Here, we combine fieldwork with museum and literature surveys to expand herbivory records for Eumaeus from 21 to 38 Zamia species. We inferred a time-calibrated phylogeny of Eumaeus to test for distinct macroevolutionary scenarios of larval host plant conservatism and co-evolution. We found a remarkable coincidence between Eumaeus and Zamia diversification, with the butterfly stem group diverging at the same time as the most recent radiation of Zamia in the Miocene. Cophylogenetic reconciliation analyses show a strong cophylogenetic signal between cycads and their butterfly herbivores. Bipartite model-based approaches indicate that this is because closely related Zamia species are used by the same Eumaeus species, suggesting larval host plant resource tracking by the butterfly herbivores. Our results highlight a case of tight evolution between Eumaeus butterflies and cycads, pointing to the generality of correlated evolution and phylogenetic tracking in plant-herbivore interactions across seed plants.

Real-life evidence of treatment with alemtuzumab in patients diagnosed with relapsing-remitting multiple sclerosis in Colombia.

BACKGROUND: Physical disability, cognitive impairment, depression, and fatigue are poorly understood in Latin American patients with multiple sclerosis following alemtuzumab infusion. OBJECTIVES: To describe Sustained changes in physical disability in an average 22-month follow-up period after alemtuzumab infusion, and which demographical or clinical variables modulate change in EDSS, and adverse events, changes in cognition, fatigue, and depressive symptoms after an average 15-month follow-up period. METHOD: Retrospective cohort observational study. Following the review of medical records, 23 patients with Relapsing Remitting Multiple Sclerosis treated with alemtuzumab were identified; of these, 17 had a baseline neuropsychological assessment and 12 had at least one follow-up neuropsychological assessment. RESULTS: Most of the patients presented a low level of physical disability, depression, fatigue, and cognitive impairment, which was more pronounced in the processing speed and visuospatial memory at baseline. Fifteen of 23 (65.2%) of patients showed disability improvement, 7 (30.1%) patients remained stable, and 1 (4.3%) patient worsened, and change was not influenced by age or baseline disability score. Twenty (87%) patients remained free of clinical relapses. Performance improved on the BVMT-R visual memory test, 9 (75%) remained stable or improved on the BICAMS, and 66.6% perceived decreased fatigue on the d-FIS. Adverse events occurred in 7 (30.1%) of patients, the most common were opportunistic infections in 2 (8.6%) patients, and one 29-year-old patient presented papillary thyroid carcinoma after infusion of the second course of alemtuzumab. CONCLUSIONS: Results suggest that treatment with alemtuzumab has a beneficial impact on disability, cognitive impairment, and perception of fatigue. The percentage and type of adverse events observed in the cohort are similar to those reported for other real-life studies.

Characterization of By-products with High Fat Content Derived from the Production of Bovine Gelatin.

Background: Gelatin is a protein obtained by partial hydrolysis of collagen contained in skins, connective tissue and/or animal bones, which are by-products of the meat industry. The main raw material to produce bovine gelatin is the dermis of the skin, but there is a variation in fat and moisture content depending on the bovine skin origin. As a contribution to the circular economy and sustainability, these by-products with high fat content and the fat released from them during the gelatin production process can be managed for food industries, mainly in the development or formulation of animal feed. Methods: For the initial physicochemical characterization, moisture, fat, protein and ashes content were determined. Once the by-products with high fat content were identified, alteration parameters such as acidity, peroxide and saponification indexes were evaluated. Additionally, thermal, rheological and fatty acid composition characterization was carried out in order to study the possible applications of the by-products. Results and Discussion: The results showed that certain by-products have a fat content of less than 15%, so the viability of their use is limited. On the other hand, some by-products have a fat content exceeding 30%; however, their extraction can only be done manually, resulting in a low efficiency process. By-products removed from the supernatant in the extractors presented fat percentages of 99.9 and 98.9%, and there exists the possibility of implementing a mechanical method for their extraction. The analysis of alteration and oxidation parameters, thermal and rheological characterization, fatty acid profile and solid fat content were exclusively conducted on these high-fat content by-products. Based on the characterization, these by-products could be valued and incorporated into animal feed formulations. Nevertheless, certain limitations exist for their use in applications such as biodiesel production or the food industry.

Development and pilot testing of a training for bilingual community education professionals about hereditary breast and ovarian cancer among Latinas: ÁRBOLES Familiares.

Cancer health disparities remain a significant problem in the USA, compounded by lack of access to care, language barriers and systemic biases in health care. These disparities are particularly evident in areas such as genetics/genomics. For example, Latinas at high risk for hereditary breast and ovarian cancer (HBOC) have extremely low rates of genetic counseling/testing. Long-standing barriers and inequities in access to services such as genetic counseling and testing require innovative solutions. One solution can involve training community outreach and education professionals (CORE-Ps) to bridge the gap between underserved communities and genetic specialists. We sought to develop and pilot test a training program for English-Spanish bilingual CORE-Ps to reduce disparities in access to and uptake of genetic services among Latino populations. Guided by Adult Learning Theory and with input from multiple stakeholders, we developed ÁRBOLES Familiares (Family Trees), an in-person and online training program for bilingual CORE-Ps to facilitate identification, referral, and navigation of Latinas to genetic counseling/testing. We conducted a pilot test of 24 CORE-Ps recruited from across the United States and assessed knowledge, genetic literacy, and self-efficacy at baseline and follow-up. At follow-up, participants in the pilot with complete baseline and follow-up data (N = 15) demonstrated significant improvements in HBOC knowledge, genetic literacy, self-efficacy and reports of fewer barriers to identify/navigate Latinas (ps < .05). Qualitative assessment identified ways to improve the training curriculum. Pilot results suggest ÁRBOLES is a promising approach for training CORE-Ps to identify and refer high-risk Latinas to genetic services. Next steps involve further refinement of ÁRBOLES, development of an online toolkit, and adaptation for virtual delivery.

Latinas at high risk for hereditary breast and ovarian cancer (HBOC) have low rates of genetic counseling and testing. Latinas may not have ready access to services like genetic counseling and testing, which need special solutions. One solution can involve training community health workers to bridge the gap between Latinas and genetic specialists. We developed an online and in person training program (ÁRBOLES Familiares or Family Trees) for English-Spanish bilingual community health workers that teaches them how to help Latinas get access to genetic services. We tested this program with a small group of community health workers. After the program, their HBOC knowledge, genetic literacy, and confidence to help Latinas get access to genetic services had improved. Trainees also made suggestions to improve the program, which will be used to help future trainees expand their knowledge and skills to work with Latinas at risk of HBOC.

Análisis retrospectivo de las enfermedades parasitarias del mono ardilla (Saimiri sciureus) en dos condiciones ex situ en el noroccidente de los Andes suramericanos / Retrospective analysis of the squirrel monkey’s (saimiri sciureus) parasitic diseases in two ex situ conditions in the northwestern Andes in South America / Análise retrospectiva das doenças parasitárias do macaco-de-cheiro (Saimiri sciureus) em duas condições ex situ no noroeste dos Andes sul-americanos

El mono ardilla (Cebidae: Saimiri sciureus) es una especie de primate neotropical. La mayor susceptibilidad a la presencia de parásitos en estos primates se puede deber a las condiciones ex situ a las que se encuentran sometidos, en donde se exponen a diferentes factores ambientales y de manejo. A partir de las historias clínicas de una población de 94 Saimiri sciureusdel Parque Zoológico Jaime Duque (PZJD) y de la Unidad de Rescate y Rehabilitación de Animales Silvestres (Urras), instituciones ubicadas al noroccidente de los Andes suramericanos, se determinó la presencia de los parásitos diagnosticados en estas dos condiciones (exhibición y rehabilitación, respectivamente), estableciendo la posible asociación con la edad, el sexo, la sintomatología y los medicamentos. Se utilizaron histogramas y prueba de chi cuadrado para definir las diferencias de parásitos en estos dos lugares y poder determinar la mayor frecuencia presente en Saimiri sciureus. Por otro lado, el limitado conocimiento y los estudios parasitológicos de estos primates delimitan la gestión pública y dificultan el establecimiento de posibles zoonosis.

The squirrel monkey (Cebidae: Saimiri sciureus) is a species of Neotropical primate. The increased susceptibility to the presence of parasites in these primates may be due to the ex situ conditions to which they are subjected, and where they are exposed to different environmental and managerial factors. The presence of the parasites diagnosed in these two conditions (exhibition and rehabilitation, respectively) was determined based on the medical records of a population of 94 Saimiri sciureus from the Jaime Duque Zoo (PZJD) and the Wild Animal Rescue and Rehabilitation Unit (Urras), both institutions located at the northwestern part of the Andes in South America, thus establishing the possible association with age, gender, symptomatology and medicine. Histograms and chi-squared tests were used to define the parasite differences in these two places and to determine the most frequent ones in Saimiri sciureus. On the other hand, the limited knowledge and parasitological studies of these primates delimitate public management and hinder the establishment of possible zoonoses.

O macaco-de-cheiro (Cebidae: Saimiri sciureus) é uma espécie de primata neotropical. A maior suscetibilidade à presença de parasitas nestes primatas pode-se dever as condições ex situ às que se encontram submetidos, onde são expostos a diferentes fatores ambientais e de manejo. A partir das histórias clínicas de uma população de 94 Saimiri sciureus do Parque Zoológico Jaime Duque (PZJD) e da Unidade de Resgate e Reabilitação de Animais Silvestres (Urras), instituições localizadas ao noroeste dos Andes sul-americanos, determinou-se a presença dos parasitas diagnosticados nestas duas condições (exibição e reabilitação, respectivamente), estabelecendo a possível associação com a idade, o sexo, a sintomatologia e os medicamentos. Foram utilizados histogramas e prova de qui-quadrado para definir as diferenças de parasitas nestes dois lugares, e poder determinar a maior frequência presente em Saimiri sciureus. Por outro lado, o limitado conhecimento e os estudos parasitológicos destes primatas delimitam a gestão pública e dificultam o estabelecimento de possíveis zoonoses.

Sector salud, conflicto armado Colombiano y Derecho Internecional Humanitario / Health system, Colombian armed conflict and humanitarian international right

La preparación de los estudiantes universitarios del área de la salud sobre la protección de la misión médica y sanitaria en zonas de conflicto armado, Medellín 2000, fue una investigación descriptiva y exploratoria que se realizó para identificar la opinión y experiencia que tenían en Medellín, Antioquia, los estudiantes del último semestre de las facultades de medicina, odontología, enfermería y bacteriología sobre el conflicto armado colombiano, sus actores, su extensión geográfica, sus efectos sobre el sector salud, los temores y las reacciones para enfrentar algunas situacines críticas generadas durante la atención en salud a la población en zonas de conflicto. Además de indagó acerca de la información que tenían sobre los deberes y derechos de la misión médica, derecho internacional humanitario (DIH) y las fuentes utilizadas para obtenerla. Para finalizar, el texto presenta algunas propuestas de la población de estudio a las universidades y servicios de atención en salud, para la capacitación de los estudiantes y de trabajadores del área. El 92 por ciento de los estudiantes próximos a graduarse reconocieron el conflicto interno que vive Colombia, el 50 por ciento tenía información sobre la protección que otorgan las normas del DIH, el 98 por ciento recibió información del conflicto a través de la televisión, y el 36 por ciento como tema dentro de un curso académico; el 98 por ciento reconoce las amenazas contra la vida como el principal efecto del conflicto en el sector salud y el 91 por ciento no sabe como reaccionar ante las situaciones de peligro que genera el conflicto. El 75 por ciento siente temor o miedo a desplazarse y el 89 por ciento no ha recibido preparación en la universidad sobre el ejercicio profesional en zonas de conflicto. Los resultados del estudio servirán a las instituciones responsables de la formación del recurso humano en salud y a los directores de las instituciones prestadoras de servivios de salud para incluir en los programas de capacitación y de formación profesional las temáticas en DIH, misión médica humanitaria y regulación de conflictos.

Gestión de planes internos y externos de emergencias en los hospitales de Medellín-2000 / Adminsitration of internal and external plans of emergencies in the hospitals of Medellin-2000

Con el fin de conocer el estado de los planes de emergencia en los hospitales de la ciudad de Medellín, se realizó un estudio de corte. Se incluyeron veintiún hospitales de II y CIII nivel de atención, a los cuales se les preguntó por la existencia de comités hospitalarios, planes internos y externos, antecedentes de emergencias, coordinación con la red de urgencias y programas de capacitación.Se encontró que el 71 por ciento de las instituciones cuentan con comité, el 86 por ciento tiene plan interno, el 67 por ciento plan externo y un 14 por ciento no tiene ningún plan. La situación encontrada es preocupante, por la falta de políticas para la actualización de los planes, asignación de responsables, inversión de tiempo para capacitación y entrenamiento, asignación de recursos para intervenir la vulnerabilidad. Estos resultados invitan a fomentar el compromiso individual y colectivo en la prevención y atención de emergencias y desastres y analizar la responsabilidad de salud ocupacional y de las administradoras de riesgos profesionales con los hospitales. La pregunta para resolver es: ¿qué hacer para que los administradores de los hospitales, tengan la claridad política, humana y administrativa en la prevención, atención en desastres, así mismo para la protección del enfermo, funcionarios y visitantes?.

La consolidación de una línea de investigación sobre Trauma / Constructing a line of investigation regarding trauma

En este artículo se describe la fundamentación teórica de la línea de investigación en trauma y el modelo de varias investigaciones construidas con trabajo interdisciplinario e interinstitucional. Se pretende mostrar el esfuerzo de un grupo de personas que se enfrenta al reto de investigar una situación problema de salud pública que compromete a diferentes áreas del conocimiento. Es responsabilidad de todos realizar actividades encaminadas a disminuir la incidencia y la consecuencia del problema que está generando el trauma en Medellín. Se considera un proyecto novedoso porque sirve de apoyo a la docencia y a la asistencia y a diferentes profesionales en el área de la salud, (médicos epidemiólogos, profesionales de enfermería, gerentes de sistemas de información en salud y profesionales del área de la salud mental, entre otros).

Trauma osteomuscular características de los pacientes admitidos en un servicio de urgencias de un hospital de tercer nivel, Medellín 1998 / characteristics of osteomuscular trauma in patients admitted to an emergency room of a tertiary care hospital, Medellín 1998

Se caracterizó una cohorte de 616 pacientes con el diagnóstico de trauma osteomuscular, atendidos en el servicio de urgencias de un hospital de tercer nivel de la ciudad de Medellín durante el período de agosto a diciembre de 1998. Para el estudio se realizó una encuesta con datos provenientes de la historia clínica, de la observación hecha por estudiantes de enfLos resultados describen las características de la población, el consumo de sustancias psicoactivas, el agente agresor y la valoración de los pacientes,stablece diferencias según tipo de fractura. La incapacidad se estudió con una escala de funcionalidad. mediante la escala pronóstica de trauma SCORE que eLos dats de rehabilitación temprana para el paciente y a la ve.z el entrenamiento para el profesional de enfermeríaos alertan sobre la necesidad de establecer programaermería y de entrevistas al paciente y a su familia.La letalidad en las personas que presentaron fractura abierta fue de 21,4 por ciento y para los de fractura cerrada fue de 7,4 por ciento, valores que sugieren adecuar unidades de trauma para la ciudad.

Cuidado de enfermería al paciente con trauma, en el servicio de urgencias en una institución de tercer nivel, Medellín, 1998 / Nursing care to trauma patients in an emergency room in a tertiary care institution, Medellín, 1998

En este trabajo se describen las características de la atención de enfermería que se brinda a los usuarios que consultaron por trauma en un servicio de urgencias de tercer nivel de la ciudad de Medellín, Colombia. Las investigadoras se basaron en las recomendaciones sobre la importancia del cuidado directo al paciente por el profesional de enfermería, el trabajo interdisciplinario y la inclusión del concepto del usuario y su familia en los planes de cuidado (como elementos fundamentales para lograr la adaptación al proceso de enfermedad en un ambiente más cálido, ético y humano, donde se obtenga la recuperación óptima y las menores secuelas posibles).Se analizó la frecuencia con que se realiza el cuidado, partiendo desde la valoración del paciente para detectar los problemas y luego las actividades encaminadas a prevenir complicaciones, éstas consideradas fundamentales en la atención inicial.Se encontraron carencias en el cuidado por circunstancias explicadas como multicausales y que tienen que ver tanto con motivación personal, preparación académica y políticas institucionales.

Situación del personal de enfermería en el servicio de urgencias en una institución de tercer nivel, en Medellín en 1998 / The conditions of nursing staff in an emergeny room of a tertiary care institution, in Medellín en 1998

Se realizó un estudio descriptivo acerca de la percepción individual del trabajo que desempeña el personal de enfermería en el servicio de urgencias de una institución hospitalaria de tercer nivel de atención en la ciudad de Medellín. Los datos se obtuvieron a través de una encuesta que fue autodiligenciada por 28 personas, en la que se indagó por las características personales: sexo, edad, tipo de contratación, horas diurAdemás se preguntó por la satisfacción personal, la cual se determina por medio de factores de motivación intrínsecos como: cantidad de trabajo, reconocimiento recibido por desempeño, capacitación e inducción. En los factores extrínsecos con: aceptación de sugerencias, estructura física, disponibilidad de recursos y salario. También se tuvo en cuenta aspectos personales como estrés, relación entre compañeros e influencia del trabajo en la vida personal.nas y nocturnas, y descansos en la jornada laboral.