Equine Placentitis in Mares Induces the Secretion of Pro-Inflammatory Cytokine eIL-1ß and the Active Extracellular Matrix Metalloproteinase (MMP)-9.

Equine placentitis is characterized by infection and inflammation of the placenta. Different biomarkers associated with this inflammatory response have been evaluated in experimentally induced equine placentitis, but not in pregnant mares with spontaneous placentitis. The aim of the current study was to determine the concentration of eIL-1ß and the activity of proMMP-2 and proMMP-9 in the serum of healthy mares and mares with placentitis on days 240 and 320 of gestation to explore whether these biomarkers are associated with equine maternal placentitis and/or with the birth of an infected or inviable foals. Serum samples were collected from sixteen pregnant English Thoroughbred mares, retrospectively classified as follows: (1) healthy mares with full-term gestation; and (2) mares with ultrasonographic signs of placentitis. The health of each foal was examined at birth, and it was decided to classify the cases into four groups: (1) healthy mares delivering a healthy foals (HM-HF, n = 6); (2) mares with USP delivering a healthy foal (USP-HF, n = 3); (3) mares with USP delivering a live septic foal (USP-LSeF, n = 4); and (4) mares with USP delivering a dead foal (USP-DF, n = 3). eIL-1ß was quantified by ELISA, and proMMP-2 and proMMP-9 activity by gelatin zymography electrophoresis. In healthy mares, the serum concentrations of eIL-1ß underwent a significant 16.5-fold increase from day 240 to day 320 of gestation. Although similar results were found in the mares with ultrasonographic signs of placentitis that delivered a healthy foal, those delivering a live septic or nonviable foal exhibited much higher concentrations of eIL-1ß. proMMP-2 and proMMP-9 activity was not associated with maternal placentitis, foal infection, or death. Hence, the presence of placentitis severe enough to affect the health of the foal can be confirmed or discarded by determining the eIL-1ß concentration in mares that have shown ultrasonographic signs of placentitis.

Prevalence of neuromyelitis optica spectrum disorder in Colombia: Analysis of the official Ministry of Health administrative registry.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a rare entity with severe inflammatory demyelinating events of the central nervous system with debilitating sequelae. Its global prevalence ranges between 0.5 and 4/100,000 individuals, with variations by region and ethnicity. Latin America lacks epidemiological data on the disease, and Colombian prevalence is unknown. OBJECTIVE: Prevalence of NMOSD in Colombia was estimated between 2017 and 2021 using the official Ministry of Health administrative database (SISPRO). METHODS: This is an observational, cross-sectional retrospective study, using data between January 2017 and December 2021 in the SISPRO database using the International Classification of Disease code for NMOSD G36.0. Prevalence by gender, age and geographic distribution was estimated using official government statistics for 2019. World Health Organization (WHO) standard population was used to adjust using the direct method. RESULTS: 2,650 patients were diagnosed with NMOSD; the average age was 44.9 years with an overall unadjusted prevalence of 5.3/100,000 individuals, higher for females (7.8) than for males (2.8). No significant changes (from 5.3 to 5.4) were seen after adjusting to the WHO standard. CONCLUSION: According to this study Colombia has one of the highest prevalence rates of NMOSD in Latin America, further studies are needed to elucidate the contributing factors.

Therapeutic plasma exchange for optic neuritis attacks in patients with neuromyelitis optica spectrum disorders.

BACKGROUND: Optic neuritis (ON) causes several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describes improvement and safety outcomes with TPE. METHODS: We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS: Eighty-three patients received 558 TPE sessions. Mean age was 40.9 years (±13.7 years); 73.5% were women, 50.1% were first attack, and 10.7% were bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32). By Keegan's criteria, 82.4% experience improvement and 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related to improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION: TPE is effective and safety for ON in NMOSD patients. There is a need for a clinical trial using a therapeutic equivalent.

Quality of life in patients with multiple sclerosis and their caregivers in Colombia: One-year follow-up. / Calidad de vida en pacientes con esclerosis múltiple y sus cuidadores en Colombia: un año de seguimiento

INTRODUCTION: Multiple sclerosis is a chronic inflammatory demyelinating disease associated with neurological disability. Clinical features include motor, cerebellar, visual, and sensory function alterations, as well as psychiatric comorbidities, such as depression, anxiety, and irritability. There is little literature available on the quality of life of patients and their caregivers. OBJECTIVE: To assess the quality of life of patients with multiple sclerosis and their caregivers in Colombia given that there is no information on the subject in this particular population to establish comprehensive management plans. MATERIALS AND METHODS: We used the MusiQol and CareQol questionnaires and the Beck Depression Inventory. A prospective analytical observational protocol was designed to include patients aged 18 to 65 years with a diagnosis of relapsing-remitting multiple sclerosis between October, 2014, and October, 2015, at the Hospital Universitario San Ignacio. We evaluated quantitative variables and Spearman correlations. The data analysis was carried out with Student t and Mann-Whitney U tests. RESULTS: A total of 55 patients with relapsing-remitting multiple sclerosis participated in the study. Chronic fatigue was the most common comorbidity in 27%. The MusiQol questionnaire revealed a good basal quality of life, which remained at similar levels in the follow-ups at six and 12 months. Quality of life was good during the study since there were no statistically significant differences between baseline and follow-up MusiQol scores. Good quality of life was also observed in caregivers. CONCLUSIONS: The quality of life of several Colombian patients diagnosed with multiple sclerosis was very good. This positive result was also observed in caregivers as evidenced by the results of the CareQol questionnaire. We also observed and indicated an inversely proportional correlation between the Expanded Disability Status Scale and the quality of life indexes.

Introducción. La esclerosis múltiple es una enfermedad desmielinizante inflamatoria crónica asociada con discapacidad neurológica que afecta la función motora, cerebelosa, visual y sensorial, y se presenta con comorbilidades psiquiátricas como depresión, ansiedad e irritabilidad. Hay escasa literatura disponible sobre la calidad de vida de los pacientes y sus cuidadores. Objetivo. Evaluar la calidad de vida de los pacientes con esclerosis múltiple y sus cuidadores en Colombia dado que no hay información sobre el tema en esta población en particular para establecer planes de manejo integral. Materiales y métodos. Se utilizaron los cuestionarios MusiQol, CareQol y el inventario de depresión de Beck. Se diseñó un protocolo observacional analítico prospectivo para pacientes de 18 a 65 años con diagnóstico de esclerosis múltiple remitente recurrente entre octubre de 2014 y octubre de 2015 en el Hospital Universitario San Ignacio. Se evaluaron variables cuantitativas y las correlaciones de Spearman. El análisis de datos se hizo mediante la prueba t de Student y la U de Mann-Whitney. Resultados. Participaron 55 pacientes diagnosticados con esclerosis múltiple remitente recurrente. En el 27 % de ellos la fatiga crónica fue la comorbilidad más frecuente. El cuestionario MusiQol reveló una buena calidad de vida de base, que se mantuvo en niveles similares en los seguimientos a los seis y los 12 meses. La calidad de vida fue buena durante el estudio y sin diferencias estadísticamente significativas entre las puntuaciones de base del cuestionario MusiQol y las de seguimiento. Se observó una buena calidad de vida en los cuidadores. Conclusiones. La calidad de vida de los pacientes colombianos participantes en el estudio con diagnóstico de esclerosis múltiple fue muy buena, así como la de los cuidadores según los resultados del cuestionario CareQol. Se observó una correlación inversamente proporcional entre la Expanded Disability Status Scale y los índices de calidad de vida.

Quality of life in patients with multiple sclerosis and their caregivers in Colombia: One-year follow-up / Calidad de vida en pacientes con esclerosis múltiple y sus cuidadores en Colombia: un año de seguimiento

Introduction: Multiple sclerosis is a chronic inflammatory demyelinating disease associated with neurological disability. Clinical features include motor, cerebellar, visual, and sensory function alterations, as well as psychiatric comorbidities, such as depression, anxiety, and irritability. There is little literature available on the quality of life of patients and their caregivers. Objective: To assess the quality of life of patients with multiple sclerosis and their caregivers in Colombia given that there is no information on the subject in this particular population to establish comprehensive management plans. Materials and methods: We used the MusiQol and CareQol questionnaires and the Beck Depression Inventory. A prospective analytical observational protocol was designed to include patients aged 18 to 65 years with a diagnosis of relapsing-remitting multiple sclerosis between October, 2014, and October, 2015, at the Hospital Universitario San Ignacio. We evaluated quantitative variables and Spearman correlations. The data analysis was carried out with Student t and Mann-Whitney U tests. Results: A total of 55 patients with relapsing-remitting multiple sclerosis participated in the study. Chronic fatigue was the most common comorbidity in 27%. The MusiQol questionnaire revealed a good basal quality of life, which remained at similar levels in the follow-ups at six and 12 months. Quality of life was good during the study since there were no statistically significant differences between baseline and follow-up MusiQol scores. Good quality of life was also observed in caregivers. Conclusions: The quality of life of several Colombian patients diagnosed with multiple sclerosis was very good. This positive result was also observed in caregivers as evidenced by the results of the CareQol questionnaire. We also observed and indicated an inversely proportional correlation between the Expanded Disability Status Scale and the quality of life indexes.

Introducción. La esclerosis múltiple es una enfermedad desmielinizante inflamatoria crónica asociada con discapacidad neurológica que afecta la función motora, cerebelosa, visual y sensorial, y se presenta con comorbilidades psiquiátricas como depresión, ansiedad e irritabilidad. Hay escasa literatura disponible sobre la calidad de vida de los pacientes y sus cuidadores. Objetivo. Evaluar la calidad de vida de los pacientes con esclerosis múltiple y sus cuidadores en Colombia dado que no hay información sobre el tema en esta población en particular para establecer planes de manejo integral. Materiales y métodos. Se utilizaron los cuestionarios MusiQol, CareQol y el inventario de depresión de Beck. Se diseñó un protocolo observacional analítico prospectivo para pacientes de 18 a 65 años con diagnóstico de esclerosis múltiple remitente recurrente entre octubre de 2014 y octubre de 2015 en el Hospital Universitario San Ignacio. Se evaluaron variables cuantitativas y las correlaciones de Spearman. El análisis de datos se hizo mediante la prueba t de Student y la U de Mann-Whitney. Resultados. Participaron 55 pacientes diagnosticados con esclerosis múltiple remitente recurrente. En el 27 % de ellos la fatiga crónica fue la comorbilidad más frecuente. El cuestionario MusiQol reveló una buena calidad de vida de base, que se mantuvo en niveles similares en los seguimientos a los seis y los 12 meses. La calidad de vida fue buena durante el estudio y sin diferencias estadísticamente significativas entre las puntuaciones de base del cuestionario MusiQol y las de seguimiento. Se observó una buena calidad de vida en los cuidadores. Conclusiones. La calidad de vida de los pacientes colombianos participantes en el estudio con diagnóstico de esclerosis múltiple fue muy buena, así como la de los cuidadores según los resultados del cuestionario CareQol. Se observó una correlación inversamente proporcional entre la Expanded Disability Status Scale y los índices de calidad de vida.

Induction of fertile estrus without the use of steroid hormones in seasonally anestrous Suffolk ewes.

OBJECTIVE: To evaluate the efficacy of treatments based on GnRH, GnRH-PGF2α, and/or intense exposure to novel rams to induce fertile estrus without the use of steroid hormones in seasonally anestrous Suffolk ewes. METHODS: In the first experiment, ewes were treated with one injection of GnRH, two injections of GnRH administered 7 days apart, or a sequence of GnRH-PGF2α-GnRH. In the second experiment anestrous ewes were exposed, for 36 days starting on the day of weaning, to groups of four rams of three different breeds that were alternated every day. Besides exposure to the males, the ewes were injected with saline solution (ME group, n=20), with GnRH (ME-GnRH group, n=20) or with a sequence of GnRH-PGF2α-GnRH (ME-GPG group, n=20). The rams used for male-effect were fitted with aprons to prevent mating, and ewes detected in estrus were bred to selected fertile rams. Ovarian activity was monitored by progesterone determinations in both experiments. RESULTS: In the first experiment sustained induction of ovarian activity was not achieved and no ewe was detected in estrus. In the second experiment induction of sustained ovarian activity was achieved in all groups. Most of the ewes were detected in estrus, 76.7 % of the ewes were mated during a 36-d breeding period and 71.7 % of all the ewes became pregnant during that period. No significant differences between groups were found for any of these variables. However, estrus detection efficiency was higher in the ME-GnRH group than in the ME group (p<0.05). CONCLUSION: An intense male-effect, that included the continuous presence and frequent alternation of several rams of different breeds, was sufficient to induce ovarian activity and fertile estrus in Suffolk ewes during the period of deep anestrus without the use of hormones, although addition of GnRH improved the efficiency of estrus detection.

Mielitis parcial excéntrica como primera manifestación de trastornos del espectro de neuromyelitis óptica: presentación de casos y revisión de la literatura / Eccentric partial myelitis as the first manifestation of optic neuromyelitis spectrum disorders

RESUMEN El entendimiento de las caracteristicas clínicas del espectro de trastornos de Neuromielitis óptica (NMOSD) con mielitis parcial y neuritis óptica típica ha ampliado el diagnóstico en casos atípicos. Presentamos el caso de una mujer de 47 años que debuta con neuritis óptica atípica y mielitis parcial. Resonancia magnética cerebral y órbitas con realce de nervio óptico, quiasma óptico y tracto óptico derecho, de columna cervical y torácica contrastada con mielitis parcial a nivel C4 y T2. Fue tratada con bolos de metilprednisolona y plasmaferesis, con buena respuesta clínica. Se realizó anticuerpos aquaporina 4 sérico positivos.

SUMMARY The understanding of the clinical characteristics of the spectrum of optic neuromyelitis disorders (NMOSD) with partial myelitis and typical optic neuritis has extended the diagnosis in atypical cases. We present the case of a 47-year-old woman who debuts with atypical optic neuritis and partial myelitis. Magnetic resonance imaging and orbits with optic nerve enhancement, optical chiasm and right optic tract, cervical and thoracic spine contrasted with partial myelitis at level C4 and T2. I t was treated with boluses of Methylprednisolone and plasmapheresis, with good clinical response. Aquaporina 4 Serum positive antibodies were performed.

Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis.

BACKGROUND: Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis. OBJECTIVE: The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis. METHODS: A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed. RESULTS: Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease. CONCLUSION: Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.

Paquimeningitis hipertrófica. Manifestación inusual en las vasculitis anca-positivas / Hypertrophic Pachymeningitis. Unusual manifestation in vasculitis anca-positive

Introducción: La vasculitis ANCA-positiva es una patología que se caracteriza por daño en vasos de pequeño calibre secundario a auto-anticuerpos. El compromiso del sistema nervioso central es poco común, con complicaciones serias y de difícil diagnóstico. Por eso presenta-mos 3 casos de pacientes con paquimeningitis hipertrófica como manifestación neurológica de vasculitis ANCA-positiva, estudiados en el Hospital Universitario San Ignacio de Bogotá. Casos:Se tratan de dos hombres y una mujer. El hombre del primer caso presentó clínica progresiva de 1 año de evolución de dolor ocular, alteración de la agudeza visual, limitación para los movimientos oculares y disartria (Imagen 1).

Luteolytic efficiency of reduced doses of cloprostenol in the ewe. Effect of progesterone concentrations at the time of treatment.

Seventy six ewes were treated with 7.5, 12.5, 25 or 50µg of cloprostenol on day 6 or 9 post-estrus to compare the luteolytic efficiency of the PGF2α analogue at each stage and to evaluate if progesterone concentrations at the time of treatment affect such efficiency. Blood samples were obtained before cloprostenol administration and 12, 24, 48, and 72h thereafter. There was an effect of dose (p<0.05) but not of day post-estrus on the proportion of animals completing luteolysis. As the dose increased, the proportion of ewes completing luteolysis also increased. Also, as the dose increased from 7.5 to 25µg, more ewes showed a transient progesterone decline instead of an absence of response, indicating that in some ewes reduced doses initiated luteolysis but were not able to finish the process. Since the dose of 25µg resulted in close to 50% luteolytic efficacy, this group was used to study the effects of progesterone concentrations at the time of treatment on the response to cloprostenol. Pre-treatment progesterone concentrations were higher (p<0.01) in ewes experiencing luteolytic failure than in those that completed luteolysis. There was a negative correlation between initial progesterone concentrations and their reduction by 12h post-treatment. It is concluded that high progesterone concentrations are associated with a reduction in sensitivity to small doses of cloprostenol. Possible mechanisms and implications of this luteoprotective effect are discussed.

Ovarian dynamics and estrous cycle length in the donkey (Equus asinus).

Nine jennies were monitored daily by ultrasonography during three complete ovarian cycles in order to evaluate if the timing of luteolysis and the growth pattern of the ovulatory follicle (OVF) before, during and after luteolysis are related to the length of the interovulatory interval (IOI). Blood samples for progesterone determination were obtained daily during one of the cycles of each jenny. The cycles were classified according to the length of the IOI into three groups: Short IOI (21.2 ± 0.3 d, n = 10), medium IOI (23.9 ± 0.4 d, n = 7), and long IOI (26.2 ± 0.3 d, n = 10). Neither the time of luteolysis onset nor the time of luteolysis completion were significantly different between groups. The length of the IOI was mainly determined by the duration of the follicular phase, as the intervals from luteolysis onset to ovulation and from luteolysis completion to ovulation were directly correlated with the length of the IOI (p < 0.001 and p < 0.01 respectively). Multiple regression analysis revealed that the length of the IOI was negatively correlated with the size of the OVF at day 13 (p < 0.01), with its growth rate from day 13 to day 15 (p < 0.05) and with its growth rate from day 15 to day 18 (p < 0.01), and positively correlated with the final diameter of the OVF (p < 0.01). The correlation between the observed IOIs and those predicted by the multiple regression equation was highly significant (r = 0.91, p < 0.001), but the predictive ability of a simplified equation using only the diameter of the OVF at day 18 was almost as good (r = 0.89, p < 0.001). Estrus signs lasted longer and were more intense as the length of the IOI increased, and this was associated with a longer period of low progesterone concentrations during the follicular phase of jennies with longer cycles. It is concluded that the length of the luteal phase in jennies is relatively constant, and that most of the variation in the length of the IOI is associated with differences in the size of the OVF at the time of luteolysis onset and with its growth rate during the following five days.

[The cost-effectiveness of interferon beta treatment in patients with a clinically isolated syndrome in Colombia]. / Costo-efectividad del tratamiento con interferón beta en pacientes con síndrome clínico aislado de alto riesgo en Colombia.

INTRODUCTION: Approximately 85% of patients with multiple sclerosis have an initial demyelinating event. Treatment with interferon beta delays the progression of multiple sclerosis for nearly two years in patients with a clinically isolated syndrome. In Colombia, interferon is very expensive when compared to other countries. OBJECTIVE: We sought to determine the cost-effectiveness of a two-year interferon beta treatment within Colombia in patients with a clinically isolated syndrome. MATERIALS AND METHODS: Based on patient and society perspectives, a cost-effectiveness analysis was conducted using a decision tree. A variety of probabilities were defined after a systematic review of the available literature. The disease costs were calculated by reviewing medical charts at the Hospital San Ignacio University and surveys completed by multiple sclerosis patients. To control for uncertainty in these data, analysis of approximately one-thousand patients was performed using Monte Carlo methods. RESULTS: The two-year treatment cost per patient exceeds Col$ 95,000,000 (US$ 50,000). Approximately 80 % of this cost corresponds to medications (US$ 40,500). The price of relapse and indirect costs totals Col$ 41,632,149 (US$ 21,744) and Col$ 11,656,389 (US$ 6,088), respectively. Treatment represents an increase of 0.06 quality-adjusted life years (QALY). The incremental cost-effectiveness ratio exceeds the threshold, regardless of the use of Monte Carlo methods for analysis. CONCLUSION: Administering interferon beta over the course of two years to high-risk patients with a clinically isolated syndrome is not cost-effective within Colombia.

Intercambio plasmático terapéutico en enfermedades neurológicas mediadas inmunológicamente: experiencia de cuatro años del Hospital Universitario San Ignacio, Bogotá, Colombia / Therapeutic plasma exchange in immune-mediated neurological diseases: four-year experience at the University Hospital San Ignacio, Bogotá, Colombia

Introducción. El intercambio plasmático (IP) se ha convertido en una alternativa terapéutica para múltiples enfermedades. Cada día hay más evidencia científica que apoya el uso de esta terapia en varias enfermedades neurológicas. Es importante registrar la experiencia local en IP para conocer la respuesta de nuestra población a la terapia. Objetivo. Describir la experiencia del Hospital Universitario San Ignacio en IP realizado a pacientes con enfermedades neurológicas durante un período de cuatro años. Materiales y métodos. Estudio observacional retrospectivo en el que se describe a los pacientes, la técnica de la terapia, las complicaciones y la respuesta clínica de los pacientes con enfermedades neurológicas tratados con IP. Resultados. Se realizaron 106 sesiones de IP en 16 pacientes. El promedio de edad de los pacientes fue de 43 años, el 81% de los pacientes eran de sexo femenino. El 83% de las sesiones fueron indicadas por miastenia gravis, el resto por síndrome de Guillain-Barré, neuromielítis óptica, neuropatía motora multifocal y encefalitis autoinmune. Todas las sesiones fueron realizadas por técnica de filtración transmembrana. El promedio de recambios plasmáticos realizado fue 1.3. Se registraron 26 complicaciones en 20 sesiones de IP. La respuesta neurológica de los pacientes a la terapia fue la esperada y similar a la reportada en la literatura médica. Conclusión. Según la experiencia de la institución, el IP es una terapia segura y eficaz en pacientes con enfermedades neurológicas.

Introduction. Plasma exchange (PE) has become a therapeutic treatment for many neurological diseases. Each day more scientific papers are being published with evidence that approves PE for patients with immunological mediated neurological disorders. It is important to register our local experience with PE in order to understand the clinical answer to the therapy in our population. Objective. To describe the experience of the Hospital Universitario San Ignacio in treating patients with neurological disorders with PE, during a 4 year period. Materials and methods. Observational retrospective study, which describes the patients, PE technique, complications of therapy and clinical answer of patients with neurological conditions treated with PE. Results. 106 sessions of PE in 16 patients, corresponding to 23 procedures. The average age was 43 years, 81% of patients were female. 83% of sessions were done for Myasthenia gravis, the rest were done for treatment of Guillain-Barré, Optical Neuromyelitis, multifocal motor neuropathy and autoimmune encephalitis. All sessions were done by membrane filtration technique. The average plasma volume exchange was 1.3, and 20 sessions presented at least one complication. The neurological response of the patients was the expected and was similar to those reported in the literature. Conclusions. Based on the experience of our medical center, PE is a safe and effective therapy for patients with some immunological mediated neurological disorders.

Costo-efectividad del tratamiento con interferón beta en pacientes con síndrome clínico aislado de alto riesgo en Colombia / The cost-effectiveness of interferon beta treatment in patients with a clinically isolated syndrome in Colombia

Introducción. En 85 % de los pacientes con esclerosis múltiple se presenta como manifestación inicial un primer evento desmielinizante o síndrome clínico aislado. En estos casos, el tratamiento con interferón beta retrasa hasta dos años la progresión a esclerosis múltiple. Sin embargo, en Colombia este medicamento es costoso. Objetivo. Determinar si el tratamiento del síndrome clínico aislado con interferón beta es costo-efectivo al retrasar la esclerosis múltiple en dos años. Materiales y métodos. Se realizó un análisis de costo-efectividad empleando un árbol de decisiones basado en la perspectiva del paciente y la sociedad. A partir de una revisión sistemática de la literatura y de conceptos de expertos se definieron las diversas probabilidades. Los costos de la enfermedad se calcularon por medio de la revisión de historias y la aplicación de encuestas a los pacientes atendidos en el Hospital Universitario San Ignacio. Para controlar la incertidumbre se realizó un análisis de sensibilidad mediante una simulación de Monte Carlo con mil pacientes. Resultados. El costo del tratamiento con interferón sobrepasa los Col$ 95´000.000 (US$ 50.000) por paciente durante los dos años. Aproximadamente, 80 % corresponde a los costos del medicamento. El costo de la recaída se acerca a Col$ 39´139.200 (US$ 21.744), y los costos indirectos corresponden a Col$ 10´958.400 (US$ 6.088). La tasa representativa del mercado fue de Col$ 1.800. Con el tratamiento se ganan sólo 0,06 años de vida ajustados por discapacidad (AVAD) adicionales. La razón de costo-efectividad ‘incremental´ (sic.) supera el umbral, incluso en el análisis de sensibilidad. Conclusión. La administración de interferón beta en pacientes con síndrome clínico aislado de alto riesgo en los primeros dos años no es costo-efectiva en Colombia.

Introduction: Approximately 85% of patients with multiple sclerosis have an initial demyelinating event. Treatment with interferon beta delays the progression of multiple sclerosis for nearly two years in patients with a clinically isolated syndrome. In Colombia, interferon is very expensive when compared to other countries. Objective: We sought to determine the cost-effectiveness of a two-year interferon beta treatment within Colombia in patients with a clinically isolated syndrome. Materials and methods: Based on patient and society perspectives, a cost-effectiveness analysis was conducted using a decision tree. A variety of probabilities were defined after a systematic review of the available literature. The disease costs were calculated by reviewing medical charts at the Hospital San Ignacio University and surveys completed by multiple sclerosis patients. To control for uncertainty in these data, analysis of approximately one-thousand patients was performed using Monte Carlo methods. Results: The two-year treatment cost per patient exceeds Col$ 95,000,000 (US$ 50,000). Approximately 80 % of this cost corresponds to medications (US$ 40,500). The price of relapse and indirect costs totals Col$ 41,632,149 (US$ 21,744) and Col$ 11,656,389 (US$ 6,088), respectively. Treatment represents an increase of 0.06 quality-adjusted life years (QALY). The incremental cost-effectiveness ratio exceeds the threshold, regardless of the use of Monte Carlo methods for analysis. Conclusion: Administering interferon beta over the course of two years to high-risk patients with a clinically isolated syndrome is not cost-effective within Colombia.

Identificación de los factores de riesgo encontrados en pacientes mayores de sesenta años que desarrollaron delírium durante su hospitalización en el Hospital Universitario de San Ignacio, en Bogotá, Colombia / Identification of Risk Factors Found in Patients of More than 60 Years Old, Who Developed Delirium During their Hospitalization in the San Ignacio Hospital, at Bogotá, Colombia

Introducción: La presencia de factores precipitantes de delírium, sumados a los factores predisponentes, incrementa significativamente el riesgo de desarrollarlo durante una hospitalización. Objetivos: Conocer los factores predisponentes y precipitantes de delírium en un hospital de cuarto nivel de Bogotá. Metodología: Un estudio prospectivo de casos y controles en que se incluyeron pacientes mayores de sesenta años de edad, durante dos años (junio de 2005-junio de 2007), para identificar los factores de riesgo predisponentes y precipitantes de delírium más frecuentes. Se incluyeron 56 pacientes, de los cuales 28 desarrollaron delírium durante la hospitalización y en ellos se analizaron los factores de riesgo predisponentes y precipitantes. Se incluyeron 28 pacientes como controles que no tenían criterios de delírum y se compararon con los casos. Resultados: Dentro de los factores predisponentes más frecuentes está el uso de lentes, la enfermedad pulmonar obstructiva crónica de base, la insuficiencia cardiaca congestiva, el cáncer de base y los medicamentos; pero no se determinó que estos incrementaran de manera significativa el riesgo de delírium; mientras que dentro de los factores precipitantes fue significativa la presencia de infecciones, en particular las de vías urinarias, y neumonías, para incrementar el riesgo con un OR de 3,66 y una p = 0,028. Conclusiones: Las infecciones deben ser tenidasen cuenta como factor que incrementa el riesgode delírium...

Introduction: We thought that the presence of deliriumprecipitating factors, added to risk factors,may significantly increases the risk to develop deliriumduring hospitalization. Objetives: For thisreason the study was designed, in which patientswere included over a 2 years period in order toidentify the most frequent predisposing and precipitatingdelirium factors in our fourth categoryhospital. Methods: Over a two year period in theHospital San Ignacio in Bogota, an observational,analytical and prospective case-control studywas designed. Fifty-six (56) patients of ages morethan 60 years old were included. Twenty-eight(28) patients developed delirium during hospitalization.In order to analyze predisposing andprecipitating delirium factors in these patients,we compared this group with an equal numberof twenty-eight (28) control patients with no deliriumcriteria. Results and conclusions: It wasfound that among the most frequent predisposingfactors were the use of lenses, base Chronic ObstructivePulmonary Disease (COPD), CongestiveHeart Failure (CHF), base cancer and medicineuse, but it was not significantly determined thatthese factors increased the risk of delirium, whileamong the precipitating factors, the presence ofinfections, particularly urinary tract infection andpneumonias increased the risk significantly by anOR of 3.66 and a p = 0.028...

Síndrome de opsoclonus-mioclonus-ataxia (OMA) parainfeccioso secundario a infección por citomegalovirus / Opsoclonus myoclonus ataxia syndrome secondary to a parainfectious process by cytomegalovirus

A continuación, se presenta un paciente de 66 años con alteración en los movimientos oculares, asociado a mioclonías, disartria y ataxia cerebelosa, secundario a un proceso parainfeccioso por citomegalovirus. Posteriormente, se revisa la fisiopatología del síndrome de opsoclonus – mioclonus – ataxia, las etiologías del mismo y las opciones terapéuticas disponibles. Esta es una etiología poco frecuente del síndrome, pues sólo se encontró un caso reportado de opsoclonus mioclonus ataxia asociado a citomegalovirus.

Tratamiento actual del ataque cerebrovascular isquémico (ACV) agudo / Current treatment of acute stroke

El tratamiento del ataque cerebrovascular isquémico (ACV) agudo cambió desde la publicación, en 1995, de los resultados del estudio NINDS (National Institute of Neurological Disorders and Stroke Trial) con activador tisular del plasminógeno. En este artículo se hace una revisión de la fisiopatología del ACV isquémico agudo, la generación del edema, la evaluación clínica, las pruebas diagnósticas, los estudios clínicos, y los criterios de inclusión y de exclusión para la trombólisis intravenosa al cabo de tres horas del inicio de los síntomas.

Common epitopes in LPS of different Enterobacteriaceae are associated with an immune response against Escherichia coli O157 in bovine serum samples.

Epidemiological studies in both humans and animals conducted in Mexico have shown that the isolation frequency of Escherichia coli O157 : H7 is low. In a previous study, IgG antibodies against E. coli O157, O7 and O116 LPS were found in serum samples from children and adults with no previous history of E. coli O157 : H7 infection. The present study was designed to determine whether a similar immune response against E. coli O157 : H7 and other antigenically related bacteria was present in bovine serum samples. A total of 310 serum samples from different herds in Mexico was analysed by microagglutination assays against different enterobacterial antigens, including E. coli O157. Microagglutination assays were positive against E. coli O7 (55 %), O116 (76 %) and O157 (36 %), Escherichia hermannii (15 %), Salmonella enterica serotype Urbana (14 %) and Salmonella enterica subsp. arizonae (40 %). These results were confirmed using a specific ELISA with purified LPS. A positive reaction was observed against the LPS of E. coli O7 (29 %), O116 (12 %) and O157 (22 %), E. hermannii (4 %), Salmonella Urbana (13 %) and S. enterica subsp. arizonae (12 %). Serum absorption studies of positive serum samples indicated the existence of at least three common epitopes shared by the LPS of E. coli O7, O116 and O157, and two others between E. coli O157 and Salmonella Urbana and S. enterica subsp. arizonae. A bactericidal assay against E. coli O157 : H7 using 31 bovine serum samples was performed, and 22 (71 %) of these serum samples gave positive results. The data demonstrated that bovine serum showed a response against different enterobacteria, including E. coli O157, and that this response could be due to the presence of shared epitopes in the LPS of these organisms.

Actividad reproductiva de la oveja Pelibuey durante la época del anestro: Influencia de la presencia del macho / Reproductive Activity of Pelibuey Ewe During the Anoestrus Season: Influence of the Male Presence

Se determinó la actividad reproductiva de ovejas Pelibuey durante la época de anestro, a 19° latitud norte. Se utilizaron 26 ovejas Pelibuey adultas y 21 ovejas nulíparas, hijas de las anteriores. Durante el primer año las ovejas adultas y nulíparas fueron sometidas diariamente a la detección de celos, de diciembre a julio, utilizando machos Pelibuey provistos de mandil. Durante el segundo año, las hembras fueron aisladas de los machos y se determinó la actividad ovárica por medio de concentraciones de progesterona en los mismos meses. En el primer año, la proporción de estros encontrada de enero a abril fue mayor (P < 0,05) en las ovejas adultas (100; 96,1; 84,6 y 96,1%) que en las nulíparas (42,8; 57,1; 52,3; 61,9%), respectivamente. Diez ovejas adultas y cuatro nulíparas ciclaron de manera regular y continua durante todo el período de observación. Durante el segundo año, la actividad ovulatoria se comportó en forma diferente en ambos grupos; a partir de marzo, se muestra un descenso el cual se mantiene hasta junio en las adultas y en julio en las nulíparas. Además, los porcentajes fueron significativamente diferentes. Ocho ovejas adultas tuvieron actividad ovulatoria continua. Se concluye que algunas ovejas Pelibuey tienen capacidad para mostrar actividad reproductiva continua durante los meses del anestro. Dicha actividad es menor en las hembras nulíparas que en las adultas. La presencia del macho durante la detección de celos ejerce un efecto estimulatorio sobre la actividad estral. La identificación de ovejas con capacidad para ciclar en forma continua, abre la posibilidad de realizar un programa de selección tendente a fijar esta característica.

Reproductive activity of Pelibuey ewes during the anoestrus was determined at 19° lat.N. Twenty six adult Pelibuey ewes and their twenty one nuliparous daughters were used. During the first year, adult and nuliparous ewes were subjected to daily estrous detection from December to July with Pelibuey rams fitted with an apron. During the second year, females were isolated from males and ovarian activity was followed by progesterone concentrations for the same months. Monthly estrous proportion from January to April was higher (P < 0.05) in adult (100, 96.1, 84.6 y 96.1%) than in nuliparous ewes (42.8, 57.1, 52.3, 61.9%). In the first year, ten adult and four nuliparous ewes cycled in a regular and continuous manner during the whole observation period. During the second year, ovulatory activity showed different paterns in the experimental groups; following March, there was a percentage reduction up to June (adults) and July (nuliparous). Eigth adult ewes showed a continuos ovulatory activity. It is concluded that some Pelibuey ewes have the capacity to show a continuous reproductive activity during the anoestrus months. This capacity is lower in nuliparous than in adult ewes. The presence of the male during estrous detection exerts an stimulatory effect on estrous activity. Identification of ewes that cycle in an continuous manner open the possibility to establish a selection program toward this trait.

The accreditation system for colleges of veterinary medicine in Mexico and a comparison with the AVMA system.

This article reviews the evolution of veterinary medicine in Mexico in order to explain the foundation of the National Council for Veterinary Medicine Education (CONEVET). This institution performs college accreditation and professional certification procedures in the country. The accreditation process for colleges of veterinary medicine in Mexico is described, and the results obtained to this point are presented. A comparative analysis of veterinary education in Mexico and the United States is also presented. The veterinary college accreditation processes of the two countries are compared and their differences analyzed.