SEROSURVEY FOR SELECTED PARASITIC AND BACTERIAL PATHOGENS IN DARWIN'S FOX (LYCALOPEX FULVIPES): NOT ONLY DOG DISEASES ARE A THREAT.

The Darwin's fox (Lycalopex fulvipes) is one of the most endangered carnivores worldwide, with the risk of disease spillover from domestic dogs being a major conservation threat. However, lack of epidemiologic information about generalist, non-dog-transmission-dependent protozoal and bacterial pathogens may be a barrier for disease prevention and management. To determine the exposure of some of these agents in Darwin's fox populations, 54 serum samples were collected from 47 Darwin's foxes in Southern Chile during 2013-18 and assessed for the presence of antibodies against Brucella abortus, Brucella canis, Coxiella burnetii, pathogenic Leptospira (serovars Grippotyphosa, Pomona, Canicola, Hardjo, and Copehageni), Toxoplasma gondii, and Neospora caninum. The highest seroprevalence was detected for T. gondii (78%), followed by pathogenic Leptospira (14%). All the studied Leptospira serovars were confirmed in at least one animal. Two foxes seroconverted to Leptospira and one to T. gondii during the study period. No seroconversions were observed for the other pathogens. No risk factors, either intrinsic (sex, age) or extrinsic (season, year, and degree of landscape anthropization), were associated with the probability of being exposed to T. gondii. Our results indicate that T. gondii exposure is widespread in the Darwin's fox population, including in areas with minimal anthropization, and that T. gondii and pathogenic Leptospira might be neglected threats to the species. Further studies identifying the causes of morbidity and mortality in Darwin's fox are needed to determine if these or other pathogens are having individual or population-wide effects in this species.

Cost-effectiveness analysis of defibrotide in the treatment of patients with severe veno-occlusive disease/sinusoidal obstructive syndrome with multiorgan dysfunction following hematopoietic cell transplantation in Spain.

AIMS: This study evaluated cost-effectiveness of defibrotide vs best supportive care (BSC) for the treatment of hepatic veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS) with multiorgan dysfunction (MOD) post-hematopoietic cell transplantation (HCT) in Spain. MATERIALS AND METHODS: A two-phase Markov model, comprising a 1-year acute phase with daily cycles and a lifetime long-term phase with annual cycles, was adapted to the Spanish setting. The model included a cohort of patients with severe VOD/SOS (defined as VOD/SOS with MOD) post-HCT. For the acute phase, efficacy and VOD/SOS-related length of stay were obtained from a phase 3 defibrotide study (NCT00358501). VOD/SOS-related hospital stays were 7.5 and 23.2 days in defibrotide-treated and BSC patients, respectively. Defibrotide-treated patients spent 30% of their stay in the intensive care unit vs 60% in BSC patients. Assumptions for the long-term phase and utility values were obtained from the literature. Costs were from the Spanish Health System perspective (€2019). Defibrotide cost was based on 25 mg/kg/day over 17.5 days, using local expert opinion. Life-years (LYs), quality-adjusted LYs (QALYs), and costs were estimated over a lifetime horizon, applying a 3% discount rate for costs and outcomes. Sensitivity analyses assessed the robustness of the results. RESULTS: Defibrotide produced an additional 1.214 QALYs and 1.348 LYs vs BSC, with a total cost of €33,708 more than BSC alone. However, defibrotide resulted in savings up to €16,644/patient for cost of hospital stay. Difference between costs and effective measures led to ratios of €27,757/QALY and €25,007/LY gained. Additional hospital stays had the greatest influence on base-case results. Probabilistic analysis confirmed the robustness of the deterministic results. LIMITATIONS: Limitations include use of historical controls and assumptions extrapolated from the literature. CONCLUSIONS: This cost-effectiveness model, adapted to the Spanish setting, showed that defibrotide is a cost-effective alternative to BSC alone in patients with severe VOD/SOS post-HCT.

Uso de medicina tradicional en diabetes mellitus no insulino-dependiente / Use of traditional medicine in non insulin-dependent diabetes mellitus

Objetivos: determinar el uso de la medicina tradicional los pacientes con Diabetes Mellitus No Insulino Dependiente (DMNID) en el Servicio de Endocrinología del Hospital Nacional Guillermo Almenara Irigoyen(HNGAI). Métodos: evaluación por encuesta de 102 pacientes atendidos durante los meses de mayo y junio de 1996 en el Consultorio Externo del Servicio de Endocrinología del HNGAI. Resultados: 68,6 por ciento de los pacientes utilizaron alguna medicina tradicional, sin diferencia entre los sexos, siendo la más utilizadas la Gentianella arborocea, la Uncaria sp, y la Cyclanthera pedata. De estos pacientes, el 73 por ciento utilizó 2 o más productos, y el 60 por ciento refirió efecto favorable. El uso de la medicina tradicional no se encontró asociado al tratamiento con dieta, tabletas o insulina. Conclusiones: es frecuente el uso de la medicina tradicional por el paciente con DMNID, siendo este uso desconocido por el médico, y aun cuando no se ha demostrado científicamente efecto favorable de estas medicinas, es que los pacientes hacen uso de una gran diversidad de ellos. Se hace necesario el estudio de estos productos, para demostrar su utilidad o no en el manejo de la DMNID.

Insulinoma: enfoque multidisciplinario / Insulinoma: multidisciplinary approach

En el presente caso el diagnóstico de hipoglicemia recién fue evidenciado en la tercera hospitalización, lo que indica el carácter progresivo del cuadro y confirma la recomendación de hacer glicemia a toda emergencia médica con alteraciones de la conciencia o delirio. Restrospectivamente la glicemia de 63 mg por ciento en una hospitalización previa hubiera debido ser tomada en cuenta en relación al cuadro clínico. Es singular que se requiera de concentraciones del 20 por ciento de glucosa para normalizar la glicemia. El diagnóstico fue realizado por los altos niveles de insulina durante la hipoglicemia y no requirió de estudios más complejos como el ayuno prolongado, el test de tolbutamida, el dosaje de Peptido C, o el test de infusión de Calcio. El estudio de imágenes mediante la tomografía no fue contributorio hecho repñortado en otras series (9). En esta oportunidad no empleamos la ecografía intraoperatoria utilizada en otro caso aún no publicado aunque sin el éxito esperado por no utilizar el transductor apropiado. Las muestras tomadas por cateterización de la Porta sugieron la localización del tumor en el cuerpo del pancreas si embargo el tumor se hallaba en la cola, el error pudo deberse a la conformación del drenaje venoso. El monitoreo intraoperatorio de la glucosa y la biopsia de congelación fueron de gran utilidad y como ocurre habitualmente la experiencia del equipo quirúrgico fue determinante del éxito. El pronóstico de largo plazo es bueno, aunque es necesario tener en cuenta que la persistencia de alteraciones neuropsiquiátricas ha sido referida en pacientes sometidos a largos periodos de hipoglicemia