Costs associated with adverse events from remission induction for children with Acute Lymphoblastic Leukemia (ALL).

BACKGROUND: ALL is the most frequent hematological tumor in children, so during remission induction chemotherapy protocol (RICP) adverse events (AEs) may appear. The public program in Mexico in charge of financial support to oncologic children without social security delivered a fix amount for ALL chemotherapy, but additional money needed to treat any other unexpected condition should be taken from the budget of the oncologic healthcare providers. So the purpose of our study was to estimate and evaluate the direct medical costs associated to EAs during RICP in children with ALL. METHODS: This study was retrospective, longitudinal, and observational based on medical records review of patients in RICP. The CTCAE was used to identify and classify AEs according to a SOC category. We focused on extracting resources data that were consumed both for inpatients and outpatients AEs. A micro-costing approach was adopted which involve quantification of each healthcare resource consumed by the hospital multiplying them by unit cost. The probability distributions of data were evaluated to identify the appropriated statistical tests to be used for comparisons between groups that were performed with Wilcoxon rank sum test. Generalized linear models (GLM) were adjusted to evaluate the effects of patient characteristics on total cost. RESULTS: Forty patients accumulated 204 inpatient and 81 outpatient AEs during RICP. Comparison of total costs between groups showed an incremental cost of $7,460.23 likewise attributable to AEs. The total cost of a pediatric patient undergoing RICP without adverse events was $3,078.36 and the total cost of a patient with AEs exceeds it threefold. CONCLUSIONS: The costs associated with AEs during RICP in Mexican children with ALL representing a high burden for the healthcare provider. Generalized linear models showed that variables such as sex, risk category and alive status are associated with the total costs of AEs. This is the first study aiming to analyze the effect of ALL-related AEs on health care costs in pediatric population, so our results may help not only to local decision making but also it may contribute to the research agenda in this field.

Human papillomavirus infection and seroprevalence among female university students in Mexico.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases, and the main etiology of cervical cancer. This study was aimed to assess type-specific cervical HPV prevalence and their association with HPV-specific antibodies in a cohort of female university students. HPV genotyping was performed by amplifying and sequencing a fragment of the L1 protein. A BLAST search was performed to identify HPV types. HPV-specific IgG antibodies were measured by ELISA in serum samples. A total of 129 women participated, with an average age of 21.75 years. The prevalence of vaginal HPV infection was 74.42%. The most predominant high-risk HPV types were 18 (13.95%), 31 (10.85%), and 16 (9.3%). We found that early age at coitarche and a higher number of sexual partners were significantly associated with a high prevalence of HPV infection. In addition to sexual behavior, we observed that the presence of serum-specific IgG antibodies against HPV can impact the prevalence of the virus. Seropositivity to HPV-16 and HPV-18 was associated with a lower prevalence of HPV-16, but not for other HPV types. Of note, there was a lower proportion of HPV-specific seropositivity in women who had the presence of the same HPV type in a cervical specimen, suggesting an immunoregulatory mechanism associated with the viral infection. In conclusion, the prevalence of HPV in university women was higher than expected and it was associated with early age of sexual debut, an increasing number of sexual partners, and a low proportion of HPV seropositivity.

[Osteogenesis of human vascular endothelial cells in culture]. / Osteogénesis en cultivo de endotelio vascular humano.

INTRODUCTION: Mesenchymal stem cells have the potential to differentiate into several types of cells including osteoblasts. These stem cells have cell surface markers found on cells of endothelial and subendothelial origin of the umbilical cord vein. Taking this into consideration we have postulated that human umbilical vein endothelial cells (HUVEC) could present osteogenic differentiation as well. Gene activation that could drive osteogenic differentiation is regulated by exogenous and endogenous factors. OBJECTIVE: The induction osteogenesis in HUVEC. MATERIAL AND METHODS: We used: a) an osteogenic medium containing 0.1 microM dexamethasone, 10 microM beta-glycerophosphate, 50 microM L-ascorbic-acid 2-phosphate, 20% MCGS serum; and b) a treatment with DNA demethylating agents hydralazine and 5'-aza-2'-deoxycytidine (0.39-200 microM). Phenotypic characteristics of HUVEC were their spindle and stellate shapes with fine homogenous cytoplasm, typically associated with fibroblast-like cells. RESULTS: The control cells (without osteogenic treatment) exhibited little extracellular matrix, whereas the osteogenically treated cells appeared shortened and flattened, and they were surrounded by extracellular matrix that subsequently became mineralized in vitro. After 28 days in culture, morphologic and histochemical studies confirmed that osteogenic medium had a strong stimulatory effect on the alkaline phosphatase activity of endothelial cells, a very early marker of cell differentiation into the osteogenic lineage. Hydralazine and 5'-aza-2'-deoxycytidine, two drugs utilized in chromatin remodeling leading to gene re-expression of inactivated DNA hypermethylated islands, did not favor osteoblast differentiation. CONCLUSION: Our study shows that HUVEC can differentiate along an osteogenic lineage and thus provide an alternative source for cell-based therapies and tissue engineering strategies.