Tricobezoar gástrico: Presentación de un caso / Gastric Trichobezoar: Case Report

El bezoar es una concreción que se forma en la luz del tracto gastrointestinal por la acumulación de cuerpos extraños no digeribles. Se clasifican de acuerdo con el material que los componen, son el tricobezoar y el fitobezoar las formas más frecuentes, los cuales están compuestos de pelo y de fibras de vegetales y frutas, respectivamente. El bezoar usualmente se forma en el estómago, puede pasar al intestino delgado (síndrome de Rapunzel) y ser una causa poco frecuente de obstrucción intestinal. En este artículo se describe un caso de tricobezoar gástrico, sus hallazgos por imagen, patología y una breve revisión de la literatura. La información acerca de esta entidad es limitada y se cuenta con pocas series de casos por lo cual es necesario continuar describiendo y determinando sus hallazgos en las diferentes modalidades diagnósticas.

A bezoar is a foreign body that can form in the gastrointestinal tract due to the ingestion of non digestible substances. They are classified according to their composition, with trichobezoar and phytobezoar being the most frequent forms, and they are formed by hair and vegetable and fruits fibres respectively. A bezoar is usually formed in the stomach but can however move to the small intestine (Rapunzel syndrome) and become a low frequency cause of intestinal obstruction (0.4 to 4%). This article describes a case of gastric trichobezoar, its findings by image, pathology and a brief review of the literature. The information about this entity is limited and there are few series of cases so it is necessary to continue describing and determining their findings in the different diagnostic modalities.

Prevalencia e impacto clínico de la sensibilización a látex y frutas en estudiantes de odontología de la Universidad de Antioquia y su relación con alergia a frutas / Prevalence and clinical impact of sensitization to latex and fruits in dentistry students at the University of Antioquia, and its relationship with allergy to fruits / Prevalência e impacto clínico da sensibilização a látex e frutas em estudantes de Odontologia da Universidade de Antioquia e sua relação com alergia a frutas

Objetivo: determinar la prevalencia y el impacto clínico de la sensibilización al látex y a cinco frutas tropicales (banano, aguacate, kiwi, piña y maracuyá) en estudiantes de odontología. Métodos: estudio transversal analítico de 128 estudiantes de odontología de la Universidad de Antioquia; se recolectó la información mediante un cuestionario y se hicieron pruebas intraepidérmicas con látex y frutas. Resultados: todos los estudiantes habían tenido contacto con látex; nueve refirieron al menos un episodio de reacción adversa al contacto con látex sin sensibilización probada al mismo. Cinco informaron al menos una reacción con una de las frutas, pero los resultados fueron negativos en las pruebas cutáneas. Cuatro de los 14 que informaron síntomas gastrointestinales estaban sensibilizados al látex o a alguna de las frutas. La tasa global de sensibilización al látex fue del 3,1%. Conclusión: el porcentaje de sensibilización al látex hallado en nuestro estudio está por debajo del publicado lo que puede ser debido a la expresión de mecanismos inmunológicos diferentes a la mediación IgE. No se logró demostrar más sensibilización al látex en función del mayor número de semestres cursados. Se debe destacar la asociación entre síntomas gastrointestinales y la sensibilización tanto a frutas como al látex.

Objective: To determine the prevalence and clinical impact of sensitization to latex and to five tropical fruits (banana, avocado, kiwi, pineapple and passion fruit) in dentistry students. Methods: Analytical cross-sectional study of 128 dentistry students at University of Antioquia in Medellín, Colombia. Information was collected by means of a questionnaire and skin prick tests with latex and fruits were done. Results: All students reported having had contact with latex. Nine of them informed at least one episode of adverse reaction to contact with latex without proof of sensitization to it. Five reported at least one reaction with one of the fruits, but skin prick tests were negative. Four of the 14 students who reported gastrointestinal symptoms were sensitized to latex or to one of the tested fruits. Overall, latex sensitization rate was 3.1%. Conclusion: This percentage of sensitization to latex is lower than that in other studies; this may be due to the expression of immune mechanisms other than IgE mediation. We failed to demonstrate a higher sensitization rate to latex as students advanced in their career. The association between gastrointestinal symptoms and sensitization to both fruit and latex is to be emphasized.

Objetivo: determinar a prevalência e o impacto clínico da sensibilização ao látex e a cinco frutas tropicais (banana, abacate, kiwi, pinha e maracujá) em estudantes de odontologia. Métodos: estudo transversal analítico de 128 estudantes de odontologia da Universidade de Antioquia; coletou-se a informação mediante um questionário e se fizeram provas intraepidérmicas com látex e frutas. Resultados: todos os estudantes tinham tido contato com látex; nove referiram ao menos um episódio de reação adversa ao contato com látex sem sensibilização provada ao mesmo. Cinco informaram ao menos uma reação com uma das frutas, mas os resultados foram negativos nas provas cutâneas. Quatro dos 14 que informaram sintomas gastrointestinais estavam sensibilizados ao látex ou a alguma das frutas. A taxa global de sensibilização ao látex foi de 3,1%. Conclusão: a porcentagem de sensibilização ao látex achado em nosso estudo está por embaixo do publicado, que pode ser devido à expressão de mecanismos imunológicos diferentes à mediação IgE. Não se conseguiu demonstrar mais sensibilização ao látex em função do maior número de semestres cursados. Deve-se destacar a associação entre sintomas gastrointestinais e a sensibilização tanto a frutas como ao látex.

Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools.

BACKGROUND: Several decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results. METHODS: The World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions. RESULTS: Three cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios. CONCLUSIONS: Vaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example, incidence of pneumonia, distribution of serotypes causing pneumonia) were influential parameters in the models we compared. Understanding the differences and similarities of such CE tools through regular comparisons could render decision-making processes in different countries more efficient, as well as providing guiding information for further clinical and epidemiological research. A tool comparison exercise using standardized data sets can help model developers to be more transparent about their model structure and assumptions and provide analysts and decision makers with a more in-depth view behind the disease dynamics. Adherence to the WHO guide of economic evaluations of immunization programs may also facilitate this process. Please see related article: http://www.biomedcentral.com/1741-7007/9/55.

Results from evaluations of models and cost-effectiveness tools to support introduction decisions for new vaccines need critical appraisal.

The World Health Organization (WHO) recommends that the cost-effectiveness (CE) of introducing new vaccines be considered before such a programme is implemented. However, in low- and middle-income countries (LMICs), it is often challenging to perform and interpret the results of model-based economic appraisals of vaccines that benefit from locally relevant data. As a result, WHO embarked on a series of consultations to assess economic analytical tools to support vaccine introduction decisions for pneumococcal, rotavirus and human papillomavirus vaccines. The objectives of these assessments are to provide decision makers with a menu of existing CE tools for vaccines and their characteristics rather than to endorse the use of a single tool. The outcome will provide policy makers in LMICs with information about the feasibility of applying these models to inform their own decision making. We argue that if models and CE analyses are used to inform decisions, they ought to be critically appraised beforehand, including a transparent evaluation of their structure, assumptions and data sources (in isolation or in comparison to similar tools), so that decision makers can use them while being fully aware of their robustness and limitations.