Cost-effectiveness analysis of intralesional and perilesional recombinant human epidermal growth factor vs hydrocolloid therapy in venous ulcer treatment in the Colombian context.

OBJECTIVE: To perform a comparative analysis of health care expenses and outcomes in response to the question: What is the cost-effectiveness of intralesional and perilesional recombinant human epidermal growth factor (rhEGF) compared with hydrocolloid therapy in patients diagnosed with chronic venous insufficiency without infection in Colombia? METHODS: A Markov model was used to determine cost effectiveness over a 5-year period, considering the perspective of the health system in Colombia. The study included patients aged >18 years diagnosed with chronic venous insufficiency and used clinical studies to calculate the probabilities of epithelialization, infection, recurrence, and mortality. RESULTS: RhEGF is more expensive per unit than hydrocolloids, but it is proven to be effective at healing ulcers in 8 to 12 weeks, even in complex cases. Hydrocolloids, in contrast, typically require 29.5 weeks on average, and ≤46 weeks for complex cases. Despite the cost, rhEGF is more cost effective because it achieves results comparable with hydrocolloid therapy at a lower cost per additional quality-adjusted life-year. CONCLUSIONS: Based on cost-effectiveness analysis, rhEGF is a superior alternative to hydrocolloids for treating venous ulcers in Colombia. Not only is it more affordable, but it also enhances patients' quality of life and streamlines the health care system's resource use.

Use of Intralesional and Perilesional Human Recombinant Epidermal Growth Factor (hrEGF) in the Local Treatment of Venous Ulcer - Review Article - Expert Recommendation.

Venous Ulcers (VU) represent 60-80% of all leg ulcers and are the final stage of the disease secondary to venous hypertension or valve insufficiency. Conventional treatment that focuses on its etiological factors continues to be the gold standard; however, 30% of ulcers do not heal with this treatment; thus, it has been seen that the use of growth factor can be used as an adjuvant for this pathology. A literature review was carried out to evaluate the evidence from systematic reviews, meta-analyses, case studies, and quantitative studies that respond to the objective of this analysis review in the different databases with specific inclusion criteria with publications between 2002 and 2022, initially finding the topical application of the factor and later, more recently, the intralesional and perilesional application, the latter being an alternative treatment for this type of pathology and generating some recommendations for using the Factor.

Socio-Demographic Characteristics and Associated Factors of Morbidity in Patients with Venous Ulcers Treated in Two Institutions of Contributive and Subsidized Regime in Colombia: Retrospective, Multicenter, Observational Study.

Aim: Venous ulcers are the most serious complication of chronic venous insufficiency secondary to venous hypertension and represent between 80% and 90% of all ulcers vascular, having socioeconomic repercussions and on the patient's quality of life. Objective: To determine the factors associated and complications with the morbidity of patients with venous ulcers CEAP 6 in two health delivery systems in Colombia. Methodology: Observational study retrospective multicenter carried out in two health centers, one under the subsidized scheme and the other under the contributory scheme in patients captured adults over 18 years of age during the years 2018 and 2019 with a diagnosis of chronic venous insufficiency CEAP 6 performing a review to the clinical history up to 4 years before the consultation for vascular surgery of ulcerative pathology. Results: A total of 105 patients were evaluated 52% of the contributory regime and 48% patients of the subsidized regime. With 139 ulcers, 70% were women. The educational level of the population in 77% of the individuals had no schooling or only had primary education. The patients of the subsidized regime belonged to the low socioeconomic stratum vs the middle-class stratum in the contributory regime. 80.5% of the lesions are concentrated in groups less than 25 cm and 19.4% of the cases are located above 50 cm. Dressings and advanced technologies were used in 30.02% of the patients in the contributory scheme compared to 24.35% in the subsidized scheme. 37% of the subsidized scheme had contagion vs 28% of the contributory scheme. The epithelialization rates were 67.27% in the contributory regime compared to 26% in the subsidized regime. Conclusion: The prognostic factors that favor wound epithelialization are related to ulcers smaller than 25 cm, lesion evolution time under 36 months, having been managed with dressings and other advanced technologies, and belonging to the contributory regime.

Efficacy of Human Recombinant Epidermal Growth Factors vs Conventional Therapy for the Treatment of Chronic Venous Ulcers: A Retrospective Case Series.

INTRODUCTION: Venous ulcers are the terminal phase of chronic venous insufficiency, the result of induced skin disorders and maintained by persistent venous hypertension. Affecting a large part of the adult population, they drain economic resources and greatly impact patient quality of life. OBJECTIVE: The objective of this descriptive, retrospective case series was to determine the efficacy of recombinant human epidermal growth factor (rhEGF) plus compression therapy vs standard of care in 48 patients with active ulcers resulting from chronic venous insufficiency. MATERIALS AND METHODS: In this descriptive, retrospective case series, 24 patients (mean age, 62.4 years) received rhEGF by intralesional and perilesional infiltration with compression therapy, and 24 patients (mean age, 69.4 years) received treatment with topical hydrocolloid gels and compression therapy. In 62.5% of patients, the ulcers were located in the internal malleoli. Ulcer progression time, ulcer size, Wollina score index, number of conventional cures, rhEGF vials used, and time to epithelialization were documented. RESULTS: Epithelialization of the active ulcer was reached in 100% of intervened patients. In the 24 patients receiving rhEGF, 71% achieved wound closure in 8 weeks or less, and the remaining percentage achieved closure within 9 and 12 weeks. In the conventional therapy group, patients achieved closure in an average of 29.5 weeks, with a minimum of 13 weeks and a maximum of 46 weeks. CONCLUSIONS: Although conventional therapy with the use of hydrocolloids and compression achieved adequate epithelialization of venous ulcers, the use of rhEGF significantly decreased healing time and could be a beneficial therapy to these patients who have few therapeutic options.

Infección postoperatoria en eventrorrafías / Surgical wound infection in hernia

Introducción: la incidencia de eventraciones oscila entre uno y 16% de las laparotomías, convirtiendo la eventrorrafia en un procedimiento muy común en los servicios quirúrgicos. El National Nosocomial Infection Surveillance Systems NNISS, mostró que la infección del sitio operatorio (ISO) es la tercera infección nosocomial más frecuente en pacientes hospitalizados, con una prevalencia del 14 al 16%.' Son muchos los factores que se han relacionado con la ISO en eventrorrafias que a su vez se identifica como factor de riesgo para la recidiva de las eventraciones. Objetivo: describir la frecuencia de presentación de ISO y los factores relacionados, en pacientes a quienes se les realizó eventrorrafia. Metodología: estudio descriptivo de corte transversal en el período de julio 1 de 2004 y julio 1 de 2006 en el Hospital de San José. Se analizaron variables demográficas, quirúrgicas, las propias de la eventración y del posto-peratorio y las escalas de riesgo de infección. Resultados: de los 132 pacientes llevados a eventrorrafia, el 58.3% (77) fueron mujeres y 41.6% (55) hombres; el promedio de edad fue 50 años. La frecuencia de ISO global fue del 9% (12); la ISO superficial en diez casos (7.5%) y profunda en dos (1.5%). Los antecedentes patológicos identificados en la población con ISO fueron diabetes mellitus en 25%, enfermedad coronaria y EPOC en 8,3% y tabaquismo en 33%. En aquellos que no presentaron ISO se encontró 5%, 2,5%, 5.8% y 9% respectivamente. El tiempo promedio de cirugía fue 115 minutos en los pacientes con ISO y 86 minutos en aquellos sin ISO. El 33 % (4) con ISO requirió cirugía de urgencias por encarcelamiento. No se documentó ISO en los dos pacientes que requirieron resección intestinal. En los pacientes que no presentaron ISO, uno tuvo NNISS 3 y SENIC 4. Conclusiones: la frecuencia global de ISO y los factores de riesgo descritos en el estudio son similares a los reportes de la literatura médica. Se requiere de estudios futuros de tipo prospectivo con un adecuado seguimiento que permitan identificar factores de riesgo de ISO y hacer vigilancia sobre el comportamiento de la ISO secundaria a eventrorrafias en la institución.

Incidencia de enfermdedad febril aguda: floridablanca, agosto-octubre, 1997 / Incidence on acute febrile illness: floridablanca, august-october, 1997

Se presentan los resultados de una encuesta domiciliaria realizada entre los habitantes del área urbana del municipio de Floridablanca (101.380 habitantes, 1993) la cual se realizó con el objeto de determinar la incidencia, duración y sintomatología de las personas que en los meses de agosto a octubre de 1997 presentaron cuandro febril agudo. Se encuestaron 1182 personas que residían en 237 viviendas. La incidencia de enfermedad febril en los tres meses indagados fue de 89.9 episodios/mes por cada 1000 personas (IC: 95 por ciento 79.4 a 100.8 casos/mes). Los episodios febriles significaron 926 días de enfermedad (8.7 días saludables perdidos por cada 1000 días-persona); (Intervalo de confianza 95 porciento 8.1 a 9.3 días), siendo notable el incremento declarado en el mes inmediatamente anterior a la realización de la encuesta. Se detetó una mayor incidencia de casos en el sector II del municipio. Los síntomas más frecuentemente, asociados a la fiebre fueron debilidad (82.3 porciento), cefalea (82.6 porciento) y dolor en extremidades (66.4 porciento). Un 61.8 porciento de los enfermos (IC 95 porciento 55.0 a 67.8 porciento) buscaron asistencia médica (40.6 consultas al mes por cada 1000 habitantes; IC 95 porciento de 36.3 a 44.8 consultas). El 80.3 por ciento de los casos eran compatibles con dengue (IC: 95 por ciento de 74.7 a 85.2 por ciento), en donde el 62.8 por ciento consultaron al médico (IC 95 porciento de 55.4 a 69.7 porciento) y el 11.7 porciento tuvieron manifestaciones hemorrágicas (IC: 95 por ciento de 7.5 a 17.2 por ciento). La incidencia de enfermedad febril aguda revela que durante el periodo de tiempo indagado se presentó una cifra apreciable de casos, de los cuales la mayoría pasaron desapercibidos por los servicios de salud, tanto públicos como privados. Con estos resultados, se evidencia el impoacto que sobre la comunidad tiene el dengue, así como la necesidad de intensificar las medidas de prevención y control