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OBJECTIVES: To evaluate cost-effective pharmacological treatment in adult kidney transplant recipients from the perspective of the Colombian health system. METHODS: A decision tree model for the induction phase and a Markov model for the maintenance phase were built. A review of the clinical literature was conducted to extract probabilities, and the life-years were used as the outcome. Costs were calculated using the administrative databases. The evaluating treatment schemes are organized by groups of evidence with direct comparisons. RESULTS: In the induction phase, anti-thymocyte immunoglobulin+ methylprednisolone is dominant, more effective, and less expensive, compared with basiliximab+methylprednisolone. In the maintenance phase, azathioprine (AZA) is dominant in contrast to mycophenolate mofetil (MFM) both with cyclosporine (CIC)+ corticosteroids (CE); CIC is dominant relative to sirolimus (SIR) and tacrolimus (TAC) (both with MFM+CE or AZA+CE), and TAC is dominant compared with SIR (in addition with MFM+CE or mycophenolate sodium [MFS]+CE); MFM is dominant in relation to MFS and everolimus, and SIR is more effective MFM but it does not exceed the threshold (in sum with TAC+CE); MFS and MFM are dominant relative to everolimus, and SIR is more effective than MFM, but it does not exceed the threshold (in addiction with CIC+CE); MFM is dominant in relation to TAC (in sum with SIR+CE), and CIC+AZA+CE is dominant in relation to TAC+MFM+CE. CONCLUSIONS: The base-case results for all evidence groups are consistent with the different sensitivity analyses.
Assuntos
Imunossupressores , Transplante de Rim , Adulto , Humanos , Corticosteroides/uso terapêutico , Corticosteroides/economia , Azatioprina/uso terapêutico , Azatioprina/economia , Colômbia , Análise de Custo-Efetividade , Ciclosporina/uso terapêutico , Ciclosporina/economia , Árvores de Decisões , Rejeição de Enxerto/prevenção & controle , Rejeição de Enxerto/economia , Imunossupressores/economia , Imunossupressores/uso terapêutico , Transplante de Rim/economia , Cadeias de Markov , Ácido Micofenólico/uso terapêutico , Ácido Micofenólico/economia , Sirolimo/uso terapêutico , Sirolimo/economia , Tacrolimo/economia , Tacrolimo/uso terapêutico , Transplantados/estatística & dados numéricosRESUMO
The aim of this study was to associate FGFR4 rs1966265 and rs351855 variants with colorectal cancer (CRC) in a Mexican population and to perform in silico analysis. Genomic DNA from 412 healthy individuals and 475 CRC patients was analyzed. In silico analysis was performed using the PolyPhen-V2, GEPIA, GTEx, and Cytoscape platforms. The GA genotype dominant model (GAAA) of rs1966265 and the AA genotype dominant and recessive models of rs351855 were identified as CRC risk factors (p < 0.05). CRC patients aged ≥ 50 years at diagnosis who consumed alcohol had a higher incidence of the rs351855 GA genotype than the control group (p < 0.05). Associations were observed between the rs1966265 GA genotype and patients with rectal cancer and stage III-IV disease. The rs351855 AA genotype was a risk factor for partial chemotherapy response, and the GA + AA genotype for age ≥ 50 years at diagnosis and rectal cancer was associated with a partial response to chemotherapy (p < 0.05). The AA haplotype was associated with increased susceptibility to CRC. In silico analysis indicated that the rs351855 variant is likely pathogenic (score = 0.998). Genotypic expression analysis in blood samples showed statistically significant differences (p < 0.05). EFNA4, SLC3A2, and HNF1A share signaling pathways with FGFR4. Therefore, rs1966265 and rs351855 may be potential CRC risk factors.
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Using cytotoxic reducing and stabilizing agents in the synthesis of gold nanoparticles (AuNPs) limits their use in biomedical applications. One strategy to overcome this problem is using "green" synthesis methodologies using polysaccharides. In the present study, we propose a green methodology for synthetizing AuNPs with mesquite gum (MG) as a reducing agent and steric stabilizer in Gold(III) chloride trihydrate aqueous solutions to obtain biocompatible nanoparticles that can be used for biomedical applications. Through this method, AuNPs can be produced without using elevated temperatures or pressures. For synthetizing gold nanoparticles coated with mesquite gum (AuNPs@MG), Gold(III) chloride trihydrate was used as a precursor, and mesquite gum was used as a stabilizing and reducing agent. The AuNPs obtained were characterized using UV-Vis spectroscopy, dynamic light scattering, transmission electron microscopy, scanning transmission electron microscopy, and FT-IR spectroscopy. The stability in biological media (phosphate buffer solution), cytotoxicity (MTT assay, hematoxylin, and eosin staining), and hemocompatibility (Hemolysis assay) were measured at different concentrations and exposure times. The results showed the successful synthesis of AuNPs@MG with sizes ranging from 3 to 30 nm and a zeta potential of -31 mV. The AuNPs@MG showed good colloidal stability in PBS (pH 7.4) for up to 24 h. Finally, cytotoxicity assays showed no changes in cell metabolism or cell morphology. These results suggest that these gold nanoparticles have potential biomedical applications because of their low cytotoxicity and hemotoxicity and improved stability at a physiological pH.
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BACKGROUND: The impact of immunosuppression in solid organ transplant recipients with SARS-CoV-2 infection is unknown. The knowledge about the behavior of different immunosuppression schemes in clinical outcomes is scarce. This study aimed to determine the risk of death in kidney transplant recipients with COVID-19 under two different schemes of immunosuppression. METHODS: We describe our experience in kidney transplant recipients with SARS-CoV-2 infection in seven transplant centers during the first year of the pandemic before starting the vaccination programs in the city of Bogotá. Demographic characteristics, clinical presentation, immunosuppression schemes at presentation, and global treatment strategies were compared between recovered and dead patients; survival analysis was carried out between calcineurin inhibitors based regimen and free calcineurin inhibitors regimen. RESULTS: Among 165 confirmed cases, 28 died (17%); the risk factors for mortality identified in univariate analysis were age older than 60 years (p=.003) diabetes (p=.001), immunosuppression based on calcineurin inhibitors (CNI) (p=.025) and patients receiving steroids (p=.041). In multivariable analysis, hypoxemia (p=.000) and calcineurin inhibitors regimen (p=.002) were predictors of death. Survival analysis showed increased mortality risk in patients receiving CNI based immunosuppression regimen vs. CNI free regimens mortality rates were, respectively, 21.7% and 8.5% (p=.036). CONCLUSIONS: Our results suggest that the calcineurin inhibitors probably do not provide greater protection compared to calcineurin inhibitor free schemes being necessary to carry out analyzes that allow us to evaluate the outcomes with different immunosuppression schemes in solid organ transplant recipients with SARS-CoV-2 infection.
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COVID-19 , Transplante de Rim , Humanos , Pessoa de Meia-Idade , Imunossupressores/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Colômbia/epidemiologia , Rejeição de Enxerto , SARS-CoV-2 , Terapia de Imunossupressão/métodosRESUMO
Esta cartilha é resultado de uma parceria entre o Conselho Estadual de Saúde do Maranhão e o projeto de pesquisa intitulado "Controle social no estado do Maranhão: perfil dos conselhos", financiado pelo Edital nº 07/2021 da Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA), e o Projeto Institucional de Bolsas de Iniciação Científica (PIBIC) da Universidade Federal do Maranhão (UFMA), cujo título é "Produção de recurso educativo para o fortalecimento de ações do controle social do estado do Maranhão", cuja coordenação e vice coordenação é feita pela Dra Judith Rafaelle Oliveira Pinho e Dra Paola Trindade Garcia, respectivamente. O objetivo dessa parceria é entregar um material didático com linguagem clara e objetiva acerca da organização e do funcionamento dos Conselhos de Saúde com base na Resolução N° 453 de 10 de maio de 2012. Portanto, este material é de acesso a todas as pessoas que tenham interesse em conhecer e compreender, de forma simplificada tal resolução, principalmente os conselheiros de saúde.
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Humanos , Controle Social Formal , Políticas, Planejamento e Administração em Saúde , Saúde , Conselhos de Saúde , Conselheiros , Pesquisa , Materiais de Ensino , OrganizaçõesRESUMO
BACKGROUND: Optic neuritis (ON) causes several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describes improvement and safety outcomes with TPE. METHODS: We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS: Eighty-three patients received 558 TPE sessions. Mean age was 40.9 years (±13.7 years); 73.5% were women, 50.1% were first attack, and 10.7% were bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32). By Keegan's criteria, 82.4% experience improvement and 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related to improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION: TPE is effective and safety for ON in NMOSD patients. There is a need for a clinical trial using a therapeutic equivalent.
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Neuromielite Óptica , Neurite Óptica , Adulto , Feminino , Humanos , Masculino , Aquaporina 4 , Modelos Logísticos , Neuromielite Óptica/terapia , Neurite Óptica/terapia , Troca Plasmática , Plasmaferese , Pessoa de Meia-IdadeRESUMO
Objetivo: Analisar as repercussões do diagnóstico do Vírus da Imunodeficiência Humana (HIV) e as perspectivas acerca do tratamento em pessoas atendidas em um centro de testagem e aconselhamento. Métodos: Realizou-se uma pesquisa qualitativa, por meio da análise de narrativas de 28 pessoas que vivem com HIV atendidas em um centro de testagem e aconselhamento de Pinheiro, Maranhão, Brasil. Durante o período de fevereiro a junho de 2019, aplicaram-se entrevistas semiestruturadas contendo questões sociodemográficas, sobre o diagnóstico e o tratamento. Resultados: Os impactos pós-diagnóstico e as pespectivas sobre o tratamento apresentaram-se como as categorias emergentes das análises. As narrativas demonstraram as formas como o diagnóstico do HIV pode refletir na vida do indivíduo, principalmente quanto às questões social e econômica e quanto ao enfrentamento de estigmas e preconceitos relativos à infecção. A terapia antirretroviral, ainda que importante para a manutenção da saúde, pode sofrer empecilhos devido aos desafios que acometem os participantes da pesquisa. Conclusão: O afastamento de familiares e amigos, o sentimento de exclusão, a maior preocupação com a saúde e a dificuldade de obter renda representam as maiores repercussões no pós-diagnóstico. assim, o tratamento é considerado uma medida de promoção à saúde e impedimento de avanço da infecção, podendo ser afetado por diversas questões, dentre elas a financeira.
Objective: To analyze the repercussions of Human Immunodeficiency Virus (HIV) diagnosis and the perspectives on the treatment in people attending a testing and counseling center. Methods: A qualitative research was carried out using analysis of narratives of 28 people living with HIV treated at a testing and counseling center in Pinheiro, Maranhão, Brazil. From February to June 2019, semi-structured interviews were carried out using sociodemographic questions about diagnosis and treatment. Results:Post-diagnosis impact and treatment perspectives were categories that emerged from the analyses. The narratives showed the ways in which the HIV diagnosis can reflect on the individual's life, especially regarding social and economic issues and the confrontation of stigma and prejudice related to the infection. Although important for the maintenance of health, antiretroviral therapy can face obstacles due to the challenges that affect the research participants. Conclusion: Distancing from family and friends, the feeling of exclusion, the greater concern with health and the difficulty in earning an income represent the greatest repercussions after diagnosis. Thus, treatment is considered a measure to promote health and prevent the progress of infection, but it can be affected by several issues, including financial ones.
Objetivo: Analizar las repercusiones del diagnóstico del Virus de la Inmunodeficiencia Humana (VIH) y las perspectivas del tratamiento de personas asistidas en un centro de pruebas para el diagnóstico y consejería. Métodos: Se realizó una investigación cualitativa a través del análisis de narrativas de 28 personas que tienen el VIH y que son asistidas en un centro de pruebas de diagnóstico y consejería de Pinheiro, Maranhão, Brasil. Se aplicaron entrevistas semiestructuradas con preguntas sociodemográficas, el diagnóstico y el tratamiento durante el período entre febrero y junio de 2019. Resultados: Los impactos posdiagnóstico y las perspectivas sobre el tratamiento se presentaron como las categorías emergentes de los análisis. Las narrativas demostraron las formas como el diagnóstico de VIH puede influenciar en la vida del individuo, en especial sobre los aspectos social y económico y sobre el enfrentamiento de los estigmas y perjuicios de la infección. La terapia antirretroviral, aunque sea importante para la manutención de la salud, puede tener objeciones debido a los desafíos que acometen los participantes de la investigación. Conclusión: El alejamiento de los familiares y los amigos, el sentimiento de exclusión, mayor preocupación con la salud y la dificultad de una renta representan las mayores repercusiones del pos diagnóstico. De esa manera, se considera el tratamiento como una medida de promoción de la salud y barrera para el avanzo de la infección que puede ser afectado por distintos aspectos, entre ellos, el financiero.
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Síndrome da Imunodeficiência Adquirida , HIV , Impacto Psicossocial , Pesquisa Qualitativa , DiagnósticoRESUMO
Impaired baroreflex sensitivity (BRS) is partially responsible for erratic blood pressure fluctuations in End-Stage Renal Disease (ESRD) patients on chronic hemodialysis (HD), which is related to autonomic nervous dysfunction. The sequence method with delayed signals allows for the measurement of BRS in a non-invasive fashion and the investigation of alterations in this physiological feedback system that maintains BP within healthy limits. Our objective was to evaluate the modified delayed signals in the sequence method for BRS assessment in ESRD patients without pharmacological antihypertensive treatment and compare them with those of healthy subjects. We recruited 22 healthy volunteers and 18 patients with ESRD. We recorded continuous BP to obtain a 15-min time series of systolic blood pressure and interbeat intervals during the supine position (SP) and active standing (AS) position. The time series with delays from 0 to 5 heartbeats were used to calculate the BRS, number of data points, number of sequences, and estimation error. The BRS from the ESRD patients was smaller than in healthy subjects (p < 0.05). The BRS estimation with the delayed sequences also increased the number of data points and sequences and decreased the estimation error compared to the original time series. The modified sequence method with delayed signals may be useful for the measurement of baroreflex sensitivity in ESRD patients with a shorter recording time and maintaining an estimation error below 0.01 in both the supine and active standing positions. With this framework, it was corroborated that baroreflex sensitivity in ESRD is decreased when compared with healthy subjects.
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Barorreflexo , Falência Renal Crônica , Humanos , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Diálise Renal , Frequência Cardíaca/fisiologiaRESUMO
In the present study, the modification of branched polyethyleneimine (b-PEI) was carried out using mesquite gum (MG) to improve its hemocompatibility to be used in biomedical applications. In the copolymer synthesis process (carboxymethylated mesquite gum grafted polyethyleneimine copolymer (CBX-MG-PEI), an MG carboxymethylation reaction was initially carried out (carboxymethylated mesquite gum (CBX-MG). Subsequently, the functionalization between CBX-MG and b-PEI was carried out using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS) as crosslinking agents. The synthesis products were characterized using Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), and thermogravimetric analysis (TGA). Thermogravimetric analysis showed that CBX-MG and CBX-MG-PEI presented a lower decomposition temperature than MG. The CBX-MG-PEI has a high buffer capacity in the pH range of 4 to 7, similar to the b-PEI. In addition, the CBX-MG-PEI showed an improvement in hemocompatibility in comparison with the b-PEI. The results showed a non-hemolytic property at doses lower than 0.1 µg/mL (CBX-MG-PEI). These results allow us to propose that this copolymer be used in transfection, polymeric nanoparticles, and biomaterials due to its physicochemical and hemocompatibility properties.