Seguridad social y medicamentos Mecanismos de cobertura de dos obras sociales en contexto de inflación 2011-2019 / Social security and medicines: coverage mechanisms of two health insurance organizations in the context of inflation, 2011-2019

INTRODUCCIÓN: La elevada inflación argentina puede comprometer el acceso a los medicamentos, incluso con cobertura de la seguridad social. El objetivo de este estudio fue describir la evolución entre 2011 y 2019 de la cobertura del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJyP, también conocido como PAMI) y del Instituto de Obra Médico Asistencial (IOMA) para una selección de medicamentos de uso ambulatorio, fuera de patente, de consumo frecuente en patologías prevalentes, y evaluar si la evolución del ingreso de los beneficiarios acompañó el aumento del gasto de bolsillo para estos fármacos. MÉTODOS: Se registró la evolución del precio de venta al público (PVP) y de la cobertura por INSSJyP y por IOMA en los cuatrienios 2011-2015 y 2015-2019 para una selección de 10 fármacos utilizados en enfermedades crónicas de alta prevalencia. Se calculó la evolución del gasto de bolsillo para las presentaciones promedio, más barata y más cara de cada fármaco, y se comparó con la evolución de los ingresos de los beneficiarios. RESULTADOS: La cobertura promedio del INSSJyP para los fármacos estudiados subió de 63% en 2011 a 73% en 2019. La cobertura del PVP promedio por el IOMA fue de 55% en 2011 y descendió a 36% en 2019, debido a la demora en la actualización de los montos fijos. Para los beneficiarios de ambas instituciones el gasto de bolsillo creció menos que el ingreso en 2011-2015 pero lo superó ampliamente en 2015-2019. DISCUSIÓN: El sistema de cobertura por monto fijo tiene ventajas conceptuales, pero requiere una actualización oportuna de los valores con la inflación

Judicialización de medicamentos de alto costo en Argentina / Judicialization of high-cost drugs in Argentina

INTRODUCCIÓN Los medicamentos de alto costo son causa frecuente de recursos de amparo. El objetivo del estudio fue identificar los medicamentos de alto costo judicializados, las patologías involucradas, el impacto económico y los factores contextuales. METODOS Se realizó un estudio descriptivo cuali-cuantitativo. Se incluyó un análisis retrospectivo de amparos por medicamentos de alto costo. Se analizaron notas periodísticas y la relación entre amparos con aprobación regulatoria e inclusión a paquetes de beneficios. RESULTADOS Se analizaron 405 amparos sobre medicamentos de alto costo entre el 01/01/2017 y 31/12/2020. El 53% de los demandantes eran mujeres, el 35% menores y más del 80% con cobertura de salud. El 42% se inició en Buenos Aires. Los medicamentos más judicializados fueron nusinersen (21,73%), palbociclib (5,93%) y agalsidasa alfa (4,69%). El 21,91% fueron en pacientes con atrofia muscular espinal y el 12,09% en cáncer de mama. El 69,35% estaban aprobados por ANMAT y el 45,74% incluido en SUR al momento del amparo El 16,80% de los casos judicializados habían sido evaluados por CONETEC. El objeto del amparo fue el rechazo a la provisión en el 80% y el fallo a favor del demandante en el 90%, con tiempo hasta el acceso de 150 días. El costo por paciente del tratamiento con nusinersen fue de ARS 28.200.000; con palbociclib de ARS 6.028.089 y con agalsidasa alfa hasta ARS 35.582.112. Se observó una relación temporal entre la aparición del nusinersen en prensa nacional y la cantidad de amparos; más de la mitad fueron previos a la aprobación de la comercialización en el país. DISCUSIÓN La judicialización se concentró en medicamentos de altísimo costo para enfermedades poco frecuentes y en medicamentos oncológicos. Casi la totalidad de los fallos son a favor del demandante, siendo los tiempos de acceso al medicamento prolongados. Los medios de comunicación y los informes de evaluación de tecnologías sanitarias podrían afectar estos procesos.

Manager's leadership is the main skill for ambulatory health care plan success.

To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

Enhanced singlet oxygen production by photodynamic therapy and a novel method for its intracellular measurement.

The generation of singlet oxygen (SO) in the presence of specific photosensitizers (PSs) or semiconductor quantum dots (QDs) and its application in photodynamic therapy (PDT) is of great interest to develop cancer therapies with no need of surgery, chemotherapy, and/or radiotherapy. This work was focused on the identification of the main factors leading to the enhancement of SO production using Rose Bengal (RB), and Methylene Blue (MB) as PS species in organic and aqueous mediums. Subsequently, the capacity of zinc oxide (ZnO), zinc sulfide (ZnS), and ZnO/ZnS core-shell QDs as well as manganese (Mn(+2)) doped ZnO and ZnS nanoparticles (NPs) as potential PS was also investigated. Many variable parameters such as type of quencher, PSs, NPs, as well as its different concentrations, light source, excitation wavelength, reaction time, distance from light source, and nature of solvent were used. The degradation kinetics of the quenchers generated by SO species and the corresponding quantum yields were determined by monitoring the photo-oxidation of the chemical quencher and measuring its disappearance by fluorometry and spectrophotometry in the presence of NPs. Small intracellular changes of SO induced by these metal Zn (zinc) NPs and PDT could execute and accelerate deadly programs in these leukemic cells, providing in this way an innovative modality of treatment. In order to perform further more specific in vitro cytotoxic studies on B-chronic lymphocytic leukemia cells exposed to Zn NPs and PDT, we needed first to measure and ascertain those possible intracellular SO variations generated by this type of treatment; for this purpose, we have also developed and tested a novel method first described by us.

Epidemiological study of shigellosis in an urban area of Argentina.

INTRODUCTION: Shigellosis represents one of the main causes of bloody diarrhoea in South America. This study aimed to establish the incidence of shigellosis in an urban zone of Buenos Aires, Argentina, by examining the type of Shigella and living conditions associated with this infection. METHODOLOGY: Between January 2009 and December 2010 we analyzed shigellosis in children admitted to the public health service with bloody diarrhoea from La Plata, the capital of Buenos Aires, Argentina. A total of 372 children under 15 years old with Shigella present in their stool samples were admitted to the study. Variables studied were patient age, type of Shigella, family economic status, and access to sewage services and safe drinking water. RESULTS: Shigella flexneri was found to be present in 66.8% of the cases. Incidence was 187 cases/year/100,000 children under 15 years old. Cases were mainly observed during the summer (38.5%) in the population of under 5 years old (69.1% of all cases). The risk of shigellosis increased 12 times in those children who lacked safe drinking water and this risk increased 1.5 times in the population without sewage services. Fewer cases of shigellosis were noted in downtown areas, while hot spots were identified in the suburbs. Treating one case of shigellosis has a local cost of US $976 while assuring safe drinking water and sewage services for one family costs US $634.  CONCLUSION: Incidence of shigellosis in urban areas is associated with quality of water and sewage services. Policies aimed at providing education and improving public utilities networks can help to reduce the incidence of shigellosis.

Could metabolic syndrome, lipodystrophy, and aging be mesenchymal stem cell exhaustion syndromes?

One of the most important and complex diseases of modern society is metabolic syndrome. This syndrome has not been completely understood, and therefore an effective treatment is not available yet. We propose a possible stem cell mechanism involved in the development of metabolic syndrome. This way of thinking lets us consider also other significant pathologies that could have similar etiopathogenic pathways, like lipodystrophic syndromes, progeria, and aging. All these clinical situations could be the consequence of a progressive and persistent stem cell exhaustion syndrome (SCES). The main outcome of this SCES would be an irreversible loss of the effective regenerative mesenchymal stem cells (MSCs) pools. In this way, the normal repairing capacities of the organism could become inefficient. Our point of view could open the possibility for a new strategy of treatment in metabolic syndrome, lipodystrophic syndromes, progeria, and even aging: stem cell therapies.

Uso de fármacos durante el período de gestación en embarazadas de Buenos Aires, Argentina / Taking medicine during pregnancy in females living in Buenos Aires, Argentina

Objetivo Describir el uso de medicamentos durante el período de gestación en embarazadas de Buenos Aires Argentina. Métodos Una muestra al azar obtenida entre mujeres que tuvieron su parto durante el año 2008 fueron encuestadas y entrevistadas respecto a datos generales, aspectos relacionados con la atención de su embarazo, características del parto y uso de fármacos durante la gestación. Las historias clínicas de las pacientes fueron revisadas para confirmar la información obtenida. Los medicamentos utilizados fueron clasificados en riesgos bajo, mediano o alto para el feto. Después del parto se realizó un examen físico a todos los recién nacidos , para detectar algún defecto congénito. Resultados Fueron incluidas en el estudio 1338 mujeres, de las cuales 90,6 por ciento ingirió al menos 1 fármaco durante el período de gestación mientras que el 81,9 por ciento utilizó medicamentos aparte del ácido fólico y hierro indicados habitualmente como profilaxis. El uso promedio de fármacos utilizado fue de 2 por paciente. Hierro (71,8 por ciento), folato (40,3 por ciento) antimicrobianos (40,9 por ciento); analgésicos (38,5 por ciento), antieméticos (30,8 por ciento) y vitaminas (19,7 por ciento) fueron los medicamentos más usados. El análisis de regresión logística sobre el uso de medicamentos mostró un incremento del uso en mujeres mayores, con un alto nivel educativo y socioeconómico. La automedicación fue del 32,3 por ciento. El uso de medicamentos considerados de alto riesgo por FDA fue del 21,5 por ciento. La incidencia de malformaciones detectadas fue del 0,6 por ciento. Conclusión Nueve de cada 10 mujeres ingirieron al menos a un fármaco durante su embarazo. Con el fin de evitar la exposición innecesaria a riesgos potenciales, el uso de medicamentos durante el período de gestación debe restringirse estrictamente a una necesidad cierta y con la mayor relación beneficio/riesgo.

Objective Describing how medicine was taken by pregnant females living in Buenos Aires, Argentina, during 2008. Methods A random sample of females who had delivered during 2008 was surveyed and interviewed regarding pertinent general data, the health care they had received during pregnancy and characteristics concerning their deliveries. Information related to antenatal care included maternal reports concerning the use of medicine during pregnancy; medicine was classified as having low, medium or high risk for the foetus. Prescriptions were also analysed. A physical examination of all newborns was performed after delivery to detect any birth defect. Results 90.6 percent of the 1,338 women included had taken at least one medicine/drug during their pregnancy and 81.9 percent had taken medicines apart from folate-iron (usually indicted as prophylaxis). Average medicine/drug use was two per pregnant female. Iron (71.8 percent), folic acid (40.3 percent), antibiotics (40.9 percent), analgesics, antiemetics (30.8 percent) and vitamins (19.7 percent) were the medicines which were most used throughout pregnancy. Logistic regression analysis of medicine use showed increased usage risk for older women, those having a higher education level or those having higher socioeconomic status. Self-medication was observed in 32.3 percent of the sample; 21.5 percent of the medicines consumed were considered as being high risk medicines by the US FDA. The incidence of malformations detected was 0.6 percent. Conclusion 9 out of 10 females had used at least one drug/medicine during their pregnancy. To avoid unnecessary exposure to potential risk during pregnancy medicine use should be strictly related to patient's health needs, in line with the best benefit/risk ratio.

[Taking medicine during pregnancy in females living in Buenos Aires, Argentina]. / Uso de fármacos durante el período de gestación en embarazadas de Buenos Aires, Argentina.

OBJECTIVE: Describing how medicine was taken by pregnant females living in Buenos Aires, Argentina, during 2008. METHODS: A random sample of females who had delivered during 2008 was surveyed and interviewed regarding pertinent general data, the health care they had received during pregnancy and characteristics concerning their deliveries. Information related to antenatal care included maternal reports concerning the use of medicine during pregnancy; medicine was classified as having low, medium or high risk for the foetus. Prescriptions were also analysed. A physical examination of all newborns was performed after delivery to detect any birth defect. RESULTS: 90.6 % of the 1,338 women included had taken at least one medicine/drug during their pregnancy and 81.9 % had taken medicines apart from folate-iron (usually indicted as prophylaxis). Average medicine/drug use was two per pregnant female. Iron (71.8 %), folic acid (40.3 %), antibiotics (40.9 %), analgesics, antiemetics (30.8 %) and vitamins (19.7 %) were the medicines which were most used throughout pregnancy. Logistic regression analysis of medicine use showed increased usage risk for older women, those having a higher education level or those having higher socioeconomic status. Self-medication was observed in 32.3 % of the sample; 21.5 % of the medicines consumed were considered as being high risk medicines by the US FDA. The incidence of malformations detected was 0.6 %. CONCLUSION: 9 out of 10 females had used at least one drug/medicine during their pregnancy. To avoid unnecessary exposure to potential risk during pregnancy medicine use should be strictly related to patient's health needs, in line with the best benefit/risk ratio.

Apoptosis induced by Magnolia Grandiflora extract in chlorambucil-resistant B-chronic lymphocytic leukemia cells.

BACKGROUND: B-cell chronic lymphocytic leukemia (B-CLL) still remains as an uncurable disease. Even the newest antineoplastic agents have demonstrated limitations in their efficacy. For this reason, further research of new compounds must be done. New pharmacological properties can be obtained from a great diversity botanical species. Among these products, Magnolia Grandiflora receives our attention since it mainly contains Honokiol which had demonstrated effect against B-CLL cells activating different cell death pathways. AIM: To test the ability of Magnolia Grandiflora extracts to induce apoptosis of B-CLL cells in vitro. MATERIALS AND METHODS: Herb's extraction: Twenty grams of powdered material were submitted to three consecutives decoctions with 500 ml of distilled water (96 °C), filtered and followed by ultrafiltration with cellulose membrane, lyophilized and reconstituted in AIM-V medium at a final concentration of 10 mg/ml solution. B-CLL chlorambucil-resistant cells were separated and cultivated in the presence of Magnolia's extract. Samples of cells were taken from the cultures at 24, 48 and 72 h for apoptosis analysis by flow cytometry measuring positive annexin V (0.1 µg/ml) cells. STATISTICS: Apoptosis values were represented by the mean plus or minus SD (± SD) for five independent experiments. Statistical significance was determined by Student's t-test. A P value of 0.05 or less was considered as significant. RESULTS AND CONCLUSION: This article discusses the apoptosis properties of Magnolia on B-CLL cells. The evidence suggests a potentially effective repertoire for B-CLL treatment. This herb extract might have promising therapy strategies in treating B-CLL or other hematological disease resistant to alkylating agents in clinical practice.

[Evaluation of the state intervention project to improve quality of life and reduce the complications associated with aging: "Add health to your years"]. / Evaluación del proyecto estatal de intervención para la mejora de la calidad de vida y la reducción de complicaciones asociadas al envejecimiento: <> .

OBJECTIVE: This paper evaluates the effectiveness of a Public Health program for the elderly based on health promotion and pathologies prevention, in order to avoid complications associated with illnesses and improves the quality of life (QOL) in elderly adults (EA). METHODS: A 12 month intervention studies used 700 EA randomized in 2 groups: intervention and control. Each group was submitted to pre-post intervention measurements that included weight, height, blood pressure (BP), cholesterol, lipids, glycaemia, cardiovascular (infarct, stroke) and bone fractures events, hospitalization, and a QOL survey. Intervention consisted of periodic physical activity to fortify muscular groups, as well as recreational activities, nutritional and food manipulation training visits. A medical student was assigned to each participant from the intervention group to assure periodical contact and to share activities. The control group continued with their normal activities during observational period. RESULTS: The intervention group showed a significant reduction in the BP, lipids and cholesterol values compared to control group. Reduction on cardiovascular events (-31%), hip fractures (-18.2%) and number of hospital admittance (-21.1%) were obtained for group A in relation to B. The QOL survey showed 28.7% improvement for group A compared with 33.4% improvement compared with control group. CONCLUSION: The health program with exhaustive follow-up administration, significantly reduced risk factors and complications associated with aging.

[Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina]. / Estudio poblacional de prevalencia de anemia en población adulta de Buenos Aires, Argentina.

OBJECTIVE: To determine the prevalence and causes of anaemia among adults in Buenos Aires, Argentina. DESIGN: Community-based, cross-sectional, quantitative study, with descriptive and analytic stages. SETTING: Study conducted in La Plata, Buenos Aires, Argentina. PARTICIPANTS: Rigorous selection from randomised sampling, with 3-stage stratification: geographical area, health aspects, and social/economic status. Adults >18 years old. RESULTS AND MAIN MEASUREMENTS: Social-economic and nutritional data and blood samples were obtained from each participant. If anaemia was detected, either treatment was given until complete recovery or further studies were conducted until definitive diagnosis was reached. Weight, height, haemoglobin, erythrocytes, haematocrit, transferrin, iron and ferritin levels, daily intake of calories, carbohydrates, lipids, proteins, calcium, iron, and vitamin C were measured. One thousand and thirty-six patients out of 1200 selected were analyzed. The prevalence of anemia in adults was 26.3%. Variables such as low social/economic status, nutritional questions, and frequency of doctor's consultation were associated with risk of anaemia. However, basic unsatisfied needs--a variable consisting of precarious housing and low educational level--, female sex, and living in slums were significant in the multivariate analysis (OR>2.5). CONCLUSIONS: One in 4 adults has anaemia, with iron deficiency as the major cause. Anaemia diagnosis is mainly associated with social and gender questions and the area of residence. This information, if used by the State to plan appropriate and focused preventive measures, could benefit not just adults but the entire community that depends on them.

Consequences of smoking during pregnancy for mother and child

Objetivos: avaliar as conseqüências para a mãe e para ofilho do hábito de fumar durante a gestação. Métodos: é um estudo prospectivo com 1.103 gestantes a partir de inquérito em mulheres atendidas no Hospital San Martin de La Plata, Buenos Aires. Amostras foram obtidas para determinação de elementos sangüineos e citometria de fluxo. O risco relativo entre fumantes e não fumantes foi calculado e se usou ainda o X2 e o teste "t" de Student. Resultados: 887 gestantes eram não fumantes e 226 fumantes. O grupo fumante teve maior probabilidade do que o não fumante para: partos prematuros, recém-natos com peso baixo, pequenos em relação à idade gestacional, maior risco de morte intra-uterina. Apgar abaixo de seis aos cinco minutos, síndrome da membrana hialina, menor número de consultas do que as programadas. A análise do sangue do cordão umbelical mostrou nas fumantes: menor número de reticulocitos, diminuição da relação CD4/CD8 e maior número de eritroblastos, eosinófilos, basófilos, linfócitos totais e CD8. Conclusões: os dados poderiam explicar observações de outros autores indicando maior incidência de alergias e infecções em recém-natos causadas por tabagismo materno.