Afectación ocular secundaria a la infección por Monkeypox virus / Ocular involvement secondary to Monkeypox virus infection

Presentamos el caso de un paciente varón de 37años con cuadro compatible con conjuntivitis adenovírica de 5días de evolución. Se pautaron corticoides tópicos, lubricantes y retirada de pseudomembranas. El análisis mediante PCR del exudado conjuntival resultó positivo para Monkeypox virus. Durante el seguimiento presentó úlceras corneales de evolución tórpida, por lo que precisó ingreso para instaurar tratamiento con tecovirimat. La afectación ocular por Monkeypox virus suele ser leve y autolimitada. Se han descrito casos con afectación visual severa cuando hay daño corneal, tal y como se ejemplifica en este caso. Tras el ingreso hospitalario para tratamiento sistémico, presentó una evolución favorable. (AU)

We present the case of a 37-year-old male patient with symptoms compatible with adenoviral conjunctivitis of 5days’ evolution. Topical corticosteroids, lubricants and removal of pseudomembranes were prescribed. PCR analysis of conjunctival exudate was positive for Monkeypox virus. During follow-up, the patient developed corneal ulcers with a torpid course, requiring admission for treatment with tecovirimat. Ocular involvement by Monkeypox virus is usually mild and self-limiting. Cases with severe visual involvement have been described when there is corneal damage, as exemplified in this case. After admission to hospital for systemic treatment, the patient progressed favourably. (AU)

Ocular involvement secondary to Monkeypox virus infection.

We present the case of a 37-year-old male patient with symptoms compatible with adenoviral conjunctivitis of 5 days' evolution. Topical corticosteroids, lubricants and removal of pseudomembranes were prescribed. PCR analysis of conjunctival exudate was positive for Monkeypox virus. During follow-up, the patient developed corneal ulcers with a torpid course, requiring admission for treatment with Tecovirimat. Ocular involvement by Monkeypox virus is usually mild and self-limiting. Cases with severe visual involvement have been described when there is corneal damage, as exemplified in this case. After admission to hospital for systemic treatment, the patient progressed favourably.

Trace element concentrations in the moss Hypnum cupressiforme growing in a presumably unpolluted area.

In this study we determined the concentrations of As, Cd, Hg, Ni and Pb in samples of the moss Hypnum cupressiforme collected during 5 different sampling surveys (2006-2014) in a presumably unpolluted area in northern Spain (25 sampling sites). We then applied factor analysis (FA) to the data to explore the factors underlying the spatial and temporal variability in the concentrations. The percentage of variance explained by the FA ranged between 34 and 98%, and was usually higher than 70%. The FA yielded 5 factors that explained the variance in the concentrations of Cd, As, Hg and Pb in all sampling surveys and also a single factor that explained the variance in Hg and Pb concentrations in 2006. Although the lack of obvious sources of pollution in the study region (at least for the elements considered) suggests that most elements (except perhaps Ni) probably originated from long-range atmospheric transport, this would not explain the results of the FA. We suggest that rather than being due to the origin of the pollutants (as frequently assumed), the spatio-temporal variability in the concentrations of these elements is probably determined by a series of other factors: the physicochemical characteristics of the pollutants and of the moss binding surfaces, physiological processes (e.g. moss growth), and the characteristics of the sampling sites (e.g. vegetation cover, elevation, slope, aspect). We therefore conclude that the assumption that variations in element concentrations in moss tissues are due to the origin of the pollutants is an oversimplification that leads to erroneous interpretation of the results of biomonitoring studies with terrestrial mosses.

Microdialysis measurements of lamellar perfusion and energy metabolism during the development of laminitis in the oligofructose model.

REASONS FOR PERFORMING STUDY: Failure of lamellar energy metabolism, with or without ischaemia, may be important in the pathophysiology of sepsis-associated laminitis. OBJECTIVES: To examine lamellar perfusion and energy balance during laminitis development in the oligofructose model using tissue microdialysis. STUDY DESIGN: In vivo experiment. METHODS: Six Standardbred horses underwent laminitis induction using the oligofructose model (OFT group) and 6 horses were untreated controls (CON group). Microdialysis probes were placed in the lamellar tissue of one forelimb (all horses) as well as the skin dermis of the tail in OFT horses. Dialysate and plasma samples were collected every 2 h for 24 h and concentrations of energy metabolites (glucose, lactate, pyruvate) and standard indices of energy metabolism (lactate to glucose ratio [L:G] and lactate to pyruvate ratio [L:P]) determined. Microdialysis urea clearance was used to estimate changes in tissue perfusion. Data were analysed nonparametrically. RESULTS: Median glucose concentration decreased to <30% of baseline by 8 h in OFT lamellar (P = <0.01) and skin (P<0.01) dialysate. Lactate increased mildly in skin dialysate (P = 0.04) and plasma (P = 0.05) but not lamellar dialysate in OFT horses. Median pyruvate concentration decreased to <50% of baseline in OFT lamellar dialysate (P = 0.03). A >5-fold increase in median L:G compared with baseline occurred in OFT lamellar and skin dialysate (P<0.03). From a baseline of <20, median L:P increased to a peak of 80 in OFT skin and 38.7 in OFT lamellar dialysates (P<0.02); however, OFT lamellar dialysate L:P was not significantly different from CON. Urea concentration decreased significantly in OFT lamellar dialysate (increased urea clearance) but not in OFT skin or CON lamellar dialysate. CONCLUSIONS: Increased lamellar perfusion occurred during the development of sepsis-associated laminitis in the oligofructose model. Glucose concentrations in the lamellar interstitium decreased, suggesting increased glucose consumption but there was no definitive evidence of lamellar energy failure.

The effect of weightbearing and limb load cycling on equine lamellar perfusion and energy metabolism measured using tissue microdialysis.

REASONS FOR PERFORMING STUDY: Lamellar perfusion is thought to be affected by weightbearing and limb load cycling; this may be critical in the development of supporting limb laminitis. OBJECTIVES: To document the effects of unilateral weightbearing and altered limb load cycling on lamellar energy metabolism and perfusion. STUDY DESIGN: Randomised, controlled (within subject), experimental trial. METHODS: Nine Standardbred horses were instrumented with microdialysis probes in the foot lamellar tissue and skin (over the tail base). Urea (20 mmol/l) was added to the perfusate. Samples were collected every 15 min for a 1 h control period, then during periods of unilateral weightbearing (opposite limb held off the ground for 1 h); enhanced static limb load cycling (instrumented limb lifted every 10 s for 30 min); reduced limb load cycling activity (i.v. detomidine sedation) and continuous walking (30 min). Dialysate concentrations of glucose, lactate, pyruvate and urea were measured and lactate:glucose (L:G) and lactate:pyruvate (L:P) ratios were calculated. For each intervention, values were compared with baseline using nonparametric statistical testing. RESULTS: Lamellar dialysate glucose increased and L:G decreased significantly during enhanced static limb load cycling. Glucose and pyruvate increased, and L:G, L:P and urea decreased significantly during walking. Simultaneous skin dialysate values did not change significantly. There were no significant dialysate changes during unilateral weightbearing or after detomidine administration, but only the latter resulted in a significant decrease in limb load cycling frequency. CONCLUSIONS: Increases in limb load cycling frequency (particularly walking) caused dialysate changes consistent with increased lamellar perfusion. Unilateral weightbearing (1 h) and a sedation-induced reduction in limb load cycling frequency did not have a detectable effect on lamellar perfusion. More research is needed to confirm the role of hypoperfusion in supporting limb laminitis, but strategies to increase limb load cycling may be important for prevention.

Microdialysis measurements of equine lamellar perfusion and energy metabolism in response to physical and pharmacological manipulations of blood flow.

REASONS FOR PERFORMING STUDY: A suitable method for evaluating lamellar perfusion changes and their metabolic consequences is currently lacking. OBJECTIVES: To examine perfusion changes in lamellar tissue using serial microdialysis measurements of urea clearance and energy metabolites. STUDY DESIGN: Randomised, controlled (within subject) experimental trial. METHODS: Nine Standardbred horses were instrumented with microdialysis probes in the foot lamellar tissue and skin (over the tail base). Urea (20 mmol/l) was added to the perfusate and its clearance was used to estimate local perfusion. Samples were collected every 15 min for a 1 h control period, then during application of a distal limb tourniquet, during periods when norepinephrine or potassium chloride (KCl) were included in both skin and lamellar perfusates, and after systemic (intravenous) acetylpromazine. Dialysate concentrations of glucose, lactate, pyruvate and urea were measured and lactate:glucose (L:G) and lactate:pyruvate (L:P) ratios calculated. Values were compared with pre-intervention baseline and also between simultaneous skin and lamellar samples using nonparametric statistical methods. RESULTS: Lamellar glucose decreased and lactate, urea, L:G and L:P increased significantly with tourniquet application, without significant changes in skin dialysate values. Lamellar and skin glucose decreased and L:G increased significantly during norepinephrine infusion, but mild increases in urea were not significant at either site. KCl caused significant decreases in lamellar and skin L:G, and an increase in skin glucose, but did not affect urea clearance. Acetylpromazine caused profound decreases in lamellar glucose and L:P, with increased L:G and pyruvate, but did not affect urea clearance or any skin dialysate values. CONCLUSIONS: Significant changes in microdialysis urea clearance only occurred with severe lamellar hypoperfusion. However, changes in dialysate metabolite concentrations reflected less profound fluctuations in perfusion. This method may be useful for examining lamellar perfusion and energy balance during laminitis development and for the evaluation of vasoactive therapeutics.

Effects of Trichothecene Production on the Plant Defense Response and Fungal Physiology: Overexpression of the Trichoderma arundinaceum tri4 Gene in T. harzianum.

Trichothecenes are fungal sesquiterpenoid compounds, the majority of which have phytotoxic activity. They contaminate food and feed stocks, resulting in potential harm to animals and human beings. Trichoderma brevicompactum and T. arundinaceum produce trichodermin and harzianum A (HA), respectively, two trichothecenes that show different bioactive properties. Both compounds have remarkable antibiotic and cytotoxic activities, but in addition, trichodermin is highly phytotoxic, while HA lacks this activity when analyzed in vivo. Analysis of Fusarium trichothecene intermediates led to the conclusion that most of them, with the exception of the hydrocarbon precursor trichodiene (TD), have a detectable phytotoxic activity which is not directly related to the structural complexity of the intermediate. In the present work, the HA intermediate 12,13-epoxytrichothec-9-ene (EPT) was produced by expression of the T. arundinaceum tri4 gene in a transgenic T. harzianum strain that already produces TD after transformation with the T. arundinaceum tri5 gene. Purified EPT did not show antifungal or phytotoxic activity, while purified HA showed both antifungal and phytotoxic activities. However, the use of the transgenic T. harzianum tri4 strain induced a downregulation of defense-related genes in tomato plants and also downregulated plant genes involved in fungal root colonization. The production of EPT by the transgenic tri4 strain raised levels of erg1 expression and reduced squalene accumulation while not affecting levels of ergosterol. Together, these results indicate the complex interactions among trichothecene intermediates, fungal antagonists, and host plants.

Equine lamellar energy metabolism studied using tissue microdialysis.

Failure of lamellar energy metabolism may contribute to the pathophysiology of equine laminitis. Tissue microdialysis has the potential to dynamically monitor lamellar energy balance over time. The objectives of this study were to develop a minimally invasive lamellar microdialysis technique and use it to measure normal lamellar energy metabolite concentrations over 24 h. Microdialysis probes were placed (through the white line) into either the lamellar dermis (LAM) (n = 6) or the sublamellar dermis (SUBLAM) (n = 6) and perfused continuously over a 24 h study period. Probes were placed in the skin dermis (SKIN) for simultaneous comparison to LAM (n = 6). Samples were collected every 2 h and analysed for glucose, lactate, pyruvate, urea and glycerol concentrations. LAM was further compared with SUBLAM by simultaneous placement and sampling in four feet from two horses over 4 h. Horses were monitored for lameness, and either clinically evaluated for 1 month after probe removal (n = 4) or subjected to histological evaluation of the probe site (n = 10). There were no deleterious clinical effects of probe placement and the histological response was mild. Sample fluid recovery and metabolite concentrations were stable for 24 h. Glucose was lower (and lactate:glucose ratio higher) in LAM compared with SUBLAM and SKIN (P < 0.05). Pyruvate was lower in SUBLAM than SKIN and urea was lower in LAM than SKIN (P < 0.05). These differences suggest lower perfusion and increased glucose consumption in LAM compared with SUBLAM and SKIN. In conclusion, lamellar tissue microdialysis was well tolerated and may be useful for determining the contribution of energy failure in laminitis pathogenesis.

Isolation of cholesterol- and deoxycholate-degrading bacteria from soil samples: evidence of a common pathway.

Nineteen different steroid-degrading bacteria were isolated from soil samples by using selective media containing either cholesterol or deoxycholate as sole carbon source. Strains that assimilated cholesterol (17 COL strains) were gram-positive, belonging to the genera Gordonia, Tsukamurella, and Rhodococcus, and grew on media containing other steroids but were unable to use deoxycholate as sole carbon source. Surprisingly, some of the COL strains unable to grow using deoxycholate as sole carbon source were able to catabolize other bile salts (e.g., cholate). Conversely, strains able to grow using deoxycholate as the sole carbon source (two DOC isolates) were gram-negative, belonging to the genus Pseudomonas, and were unable to catabolize cholesterol and other sterols. COL and DOC were included into the corresponding taxonomic groups based on their morphology (cells and colonies), metabolic properties (kind of substrates that support bacterial growth), and genetic sequences (16S rDNA and rpoB). Additionally, different DOC21 Tn5 insertion mutants have been obtained. These mutants have been classified into two different groups: (1) those affected in the catabolism of bile salts but that, as wild type, can grow in other steroids and (2) those unable to grow in media containing any of the steroids tested. The identification of the insertion point of Tn5 in one of the mutants belonging to the second group (DOC21 Mut1) revealed that the gene knocked-out encodes an A-ring meta-cleavage dioxygenase needed for steroid catabolism.

Impacts of long-term enhanced UV-B radiation on bryophytes in two sub-Arctic heathland sites of contrasting water availability.

BACKGROUND AND AIMS: Anthropogenic depletion of stratospheric ozone in Arctic latitudes has resulted in an increase of ultraviolet-B radiation (UV-B) reaching the biosphere. UV-B exposure is known to reduce above-ground biomass and plant height, to increase DNA damage and cause accumulation of UV-absorbing compounds in polar plants. However, many studies on Arctic mosses tended to be inconclusive. The importance of different water availability in influencing UV-B impacts on lower plants in the Arctic has been poorly explored and might partially explain the observed wide variation of responses, given the importance of water in controlling bryophyte physiology. This study aimed to assess the long-term responses of three common sub-Arctic bryophytes to enhanced UV-B radiation (+UV-B) and to elucidate the influence of water supply on those responses. METHODS: Responses of three sub-Arctic bryophytes (the mosses Hylocomium splendens and Polytrichum commune and the liverwort Barbilophozia lycopodioides) to +UV-B for 15 and 13 years were studied in two field experiments using lamps for UV-B enhancement with identical design and located in neighbouring areas with contrasting water availability (naturally mesic and drier sites). Responses evaluated included bryophyte abundance, growth, sporophyte production and sclerophylly; cellular protection by accumulation of UV-absorbing compounds, ß-carotene, xanthophylls and development of non-photochemical quenching (NPQ); and impacts on photosynthesis performance by maximum quantum yield (F(v) /F(m)) and electron transport rate (ETR) through photosystem II (PSII) and chlorophyll concentrations. RESULTS: Responses were species specific: H. splendens responded most to +UV-B, with reduction in both annual growth (-22 %) and sporophyte production (-44 %), together with increased ß-carotene, violaxanthin, total chlorophyll and NPQ, and decreased zeaxanthin and de-epoxidation of the xanthophyll cycle pool (DES). Barbilophozia lycopodioides responded less to +UV-B, showing increased ß-carotene and sclerophylly and decreased UV-absorbing compounds. Polytrichum commune only showed small morphogenetic changes. No effect of UV-B on bryophyte cover was observed. Water availability had profound effects on bryophyte ecophysiology, and plants showed, in general, lower growth and ETR, together with a higher photoprotection in the drier site. Water availability also influenced bryophyte responses to +UV-B and, in particular, responses were less detectable in the drier site. CONCLUSIONS: Impacts of UV-B exposure on Arctic bryophytes were significant, in contrast to modest or absent UV-B effects measured in previous studies. The impacts were more easily detectable in species with high plasticity such as H. splendens and less obvious, or more subtle, under drier conditions. Species biology and water supply greatly influences the impact of UV-B on at least some Arctic bryophytes and could contribute to the wide variation of responses observed previously.

[Dry eye and quality of life]. / Ojo seco y calidad de vida.

PURPOSE: To evaluate the relation between dry eye severity and quality of life. METHODS: 40 participants (19 with dry eye and 21 normal controls) underwent slit-lamp examination and Schirmer test to evaluate dry eye severity. Quality of life was evaluated with OSDI (Ocular Surface Disease Index) and VFQ-25 (Visual Function Questionnaire-25). RESULTS: The OSDI total score was significantly greater in patients suffering dry eye. However, BUT (break-up time) and VFQ-25 total score were significantly lower than in control subjects. In dry eye patients several statistically significant correlations (p<0.05) were found: OSDI with VFQ-25 total score (r=-0.62), BUT with corneal staining (r=-0.50) and Schirmer (0.66), BUT with OSDI total score, OSDI-symptoms and OSDI-triggers (r=-0.56, -0.56, -0.60); corneal staining with OSDI total score and OSDI-symptoms (r=0.55, 0.54), BUT with VFQ-25 total score, VFQ-25 ocular pain, mental function and role function. (r=0.56, 0.51, 0.63, 0.56); corneal staining with VFQ-25 total score, VFQ-25 ocular pain and near vision (r=-0.57, -0.49, -0.62). CONCLUSION: Quality of life is decreased in patients with dry eye. OSDI and VFQ-25 questionnaires are valid instruments for measuring the impact of dry eye disease. BUT and corneal staining provide an indirect measurement of quality of life.

Ojo seco y calidad de vida / Dry eye and quality of life

Objetivos: Evaluar la relación entre la severidad deojo seco y la calidad de vida.Material y métodos: 19 pacientes diagnosticadosde ojo seco y 21 sin ojo seco fueron explorados conlámpara de hendidura y se les realizó el test deSchirmer, para evaluar el grado de severidad de ojoseco. La calidad de vida fue valorada con los cuestionariosOSDI (Ocular Surface Disease Index) andVFQ-25 (Visual Function Questionnaire-25).Resultados: La puntuación total del OSDI era significativamentemayor en los pacientes con ojoseco, mientras que el BUT y la puntuación total delVFQ-25 era significativamente menor que en lossanos. En los casos, se encontraron las siguientescorrelaciones estadísticamente significativas(p<0,05): Puntuación total del OSDI con la puntuacióntotal del VFQ-25 (r=-0,62), BUT con la tincióncorneal (r=-0,50) y con el Schirmer (r=0,66), BUTcon la puntuación total del OSDI, los síntomas y losdesencadenantes del OSDI (r=-0,56, -0,56, -0,60);tinción corneal con la puntuación total del OSDI ylos síntomas del OSDI (r=0,55, 0,54); BUT con lapuntuación total del VFQ-25, la ausencia de dolorocular, la función mental y la función laboral delVFQ-25 (r=0,56, 0,51, 0,63, 0,56); la tinción cornealcon la puntuación total del VFQ-25, la ausenciade dolor ocular y la visión cercana del VFQ-25 (r=-0,57, -0,49, -0,62).Conclusión: Los pacientes con ojo seco tienen unapeor de calidad de vida. Tanto el OSDI como elVFQ-25 son métodos adecuados de evaluación. ElBUT y la tinción corneal proporcionan una medidaindirecta de la calidad de vida (AU)

Purpose: To evaluate the relation between dry eyeseverity and quality of life.Methods: 40 participants (19 with dry eye and 21normal controls) underwent slit-lamp examinationand Schirmer test to evaluate dry eye severity. Qualityof life was evaluated with OSDI (Ocular SurfaceDisease Index) and VFQ-25 (Visual FunctionQuestionnaire-25).Results: The OSDI total score was significantlygreater in patients suffering dry eye. However, BUT(break-up time) and VFQ-25 total score were significantlylower than in control subjects.In dry eye patients several statistically significantcorrelations (p<0.05) were found:OSDI with VFQ-25 total score (r=-0.62), BUT withcorneal staining (r=-0.50) and Schirmer (0.66),BUT with OSDI total score, OSDI-symptoms andOSDI-triggers (r=-0.56, -0.56, -0.60); corneal stainingwith OSDI total score and OSDI-symptoms(r=0.55, 0.54), BUT with VFQ-25 total score,VFQ-25 ocular pain, mental function and role function.(r=0.56, 0.51, 0.63, 0.56); corneal stainingwith VFQ-25 total score, VFQ-25 ocular pain andnear vision (r=-0.57, -0.49, -0.62).Conclusion: Quality of life is decreased in patientswith dry eye. OSDI and VFQ-25 questionnaires arevalid instruments for measuring the impact of dryeye disease. BUT and corneal staining provide an tinción corneal.indirect measurement of quality of life (AU)

Lynch syndrome in a 15-year-old boy.

Hereditary nonpolyposis colorectal cancer (HNPCC), or Lynch syndrome, dominantly inherited, is characterized by the development of a variety of cancers due to germline mutations in DNA mismatch repair genes (MMR). This syndrome was diagnosed in a 15-year-old boy because his father and grandmother were also found to have the same kind of cancer. Microsatellite instability prompted a search for germline mutations in the MLH1, MSH2, MSH6, and PMS2 genes. Use of immunohistochemical staining for MMR proteins, genomic sequencing, and deletion studies, evidenced MSH2 axonal deletion. Neoplastic lesions of colon are most often encountered in the adult population but can, on rare occasions, be found in younger patients. We would like to emphasize the importance of suspecting Lynch syndrome and performing genetic studies, even in young patients, when there is a family history of colorectal cancer.

Hydroxycinnamic acid derivatives in an aquatic liverwort as possible bioindicators of enhanced UV radiation.

We examined, under laboratory conditions, the physiological responses of the aquatic liverwort Jungermannia exsertifolia subsp. cordifolia to artificially enhanced ultraviolet (UV) radiation for 82 days, especially considering the responses of five hydroxycinnamic acid derivatives. This species lives in mountain streams, where it is exposed to low temperatures and high UV levels, and this combination is believed to increase the adverse effects of UV. Enhanced UV radiation hardly caused any change in several physiological variables indicative of vitality, such as Fv/Fm and chlorophylls/phaeopigments ratio (OD430/OD410). Thus, this liverwort seemed to be tolerant to UV radiation, probably due to the accumulation of three UV-absorbing hydroxycinnamic acid derivatives: p-coumaroylmalic acid, 5''-(7'',8''-dihydroxycoumaroyl)-2-caffeoylmalic acid, and 5''-(7'',8''-dihydroxy-7-O-beta-glucosyl-coumaroyl)-2-caffeoylmalic acid. These compounds might serve as bioindicators of enhanced UV radiation.

Intrahepatic mucinous biliary cystadenoma.

Mucinous biliary cystadenoma (MBC) is a very rare cystic tumour of the liver usually occurring in middleaged women. This condition is difficult to diagnose before surgery; differential diagnosis with hydatid disease of the liver has to be done and is difficult to distinguish from mucinous biliary cystadenocarcinoma. We report two diagnosed and treated cases of intrahepatic MBC.

Effects of cadmium and enhanced UV radiation on the physiology and the concentration of UV-absorbing compounds of the aquatic liverwort Jungermannia exsertifolia subsp. cordifolia.

The aquatic liverwort Jungermannia exsertifolia subsp. cordifolia was cultivated for 15 d under controlled conditions to study the single and combined effects of cadmium and enhanced ultraviolet (UV) radiation. Both cadmium and UV radiation caused chlorophyll degradation and a decrease in the maximum quantum yield of photosystem II (PSII), together with an increase in the mechanisms of non-photochemical dissipation of energy (increase in the xanthophyll index). Cadmium was more stressing than UV radiation, since the metal also influenced photosynthesis globally and caused a decrease in net photosynthetic rates, in the effective quantum yield of photosynthetic energy conversion of PSII, and in the maximal apparent electron transport rate through PSII. Ultraviolet radiation increased the level of trans-p-coumaroylmalic acid and cadmium increased trans-phaselic and feruloylmalic acids. The increase in these compounds was probably related to both a more efficient absorption of harmful UV radiation and an enhanced protection against oxidative stress. DNA damage was specifically caused by UV-B radiation, but was intensified under the presence of cadmium, probably because the metal impairs the DNA enzymatic repair mechanisms. Ultraviolet radiation and cadmium seemed to operate additively on some physiological processes, while other responses were probably due to either factor alone.

PROPAT: a study to improve the quality and reduce the cost of diabetes care.

OBJECTIVE: In PROPAT we implemented an integrated approach to diabetes care designed to improve the quality and reduce the cost of care. STUDY DESIGN AND METHODS: PROPAT was a case-control study matching patients by age and gender (diabetes:control ratio 1:2) within IOMA, a public employment-based health maintenance organization (HMO) of the Province of Buenos Aires, Argentina. Costs were evaluated using prevalence data from an HMO perspective. We currently report clinical and biochemical data and costs from the first 297 patients enrolled who completed 1 year in PROPAT, and compare them with those derived from control patients. RESULTS: All recommended practices recorded as care provided at baseline increased significantly 1 year after implementing PROPAT, with a parallel significant improvement in several clinical and biochemical parameters, and markedly lower total annual per capita costs. CONCLUSIONS: These results demonstrate that the implementation of a comprehensive diabetes care program can simultaneously improve quality while reducing costs.

Hospitalization and re-hospitalization of people with and without diabetes in La Plata, Argentina: comparison of their clinical characteristics and costs.

OBJECTIVE: To examine the prevalence, characteristics, and costs of hospitalization and re-hospitalization of diabetic and non-diabetic patients in La Plata, Argentina, and to compare the data with those of developed countries. RESEARCH DESIGN AND METHODS: We studied all in-hospital registries of diabetic patients enrolled in a health maintenance organization of the Province of Buenos Aires (IOMA, November 1996). For each diabetic patient (127 persons), the characteristics of two other hospitalized non-diabetic patients matched by age and gender were simultaneously recorded. RESULTS: Of the 2200 recorded hospitalizations, 5.8% were for diabetic patients, accounting for 10.5% of the hospitalization cost. Cardiovascular diseases were the major cause of hospitalization in both groups. The per capita hospitalization cost of diabetic patients was significantly higher: 1628.5+/-1754.0 US dollars versus 833+/-842 US dollars; P=0.00002. Percent re-hospitalizations were five and a half times higher in diabetic patients (P=0.0001), and significantly associated with history of severe episodes of acute (odds ratio: 3.61; 95% CI: 1.11-11.70; P=0.03) and chronic (odds ratio: 4.26; 95% CI: 1.60-11.29; P=0.004) complications. CONCLUSIONS: The combination of higher and longer hospitalization rates and frequent re-hospitalizations resulted in increased costs for our diabetic population. Implementation of care programs based on education (for physicians and patients) could effectively decrease current and future costs of the disease.