RESUMO
Tecnologías evaluadas: -Tecnologías actuales: electromiografía con electrodo de fibra única e ICE test;\r\n-Tecnología nueva: anticuerpos bloqueadores de acetilcolina receptores, prueba de Tensilon, prueba de estímulo repetitivo. Población: Esta prueba se puede aplicar a todas las edades y a todos los sexos, ya que la aparición de la enfermedad puede presentarse en toda la población. Perspectiva: Tercer pagador - Sistema General de Seguridad en Salud (SGSSS) colombiano. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Solo se tuvieron en cuenta los costos de las pruebas: -Electromiografía con electrodo de fibra única: $71.262,1; -Ice test: $26.223,3; Prueba completa de Tensilon: $24.000; -Prueba de estímulo repetitivo: $46.219,1; -Test de anticuerpos contra receptor de acetilcolina por RIA (ACRA): $45.416. Fuente de costos: Para todas las pruebas diagnósticas se utilizó el promedio ponderado estimado desde los registros de uso de servicios de 2014 SISPRO (módulo de prestación de servicios, mediante conexión OBDS), teniendo como corte de búsqueda la fecha del desarrollo de este impacto (20/10/2015). Todos los costos de las pruebas son ponderados por el número de unidades utilizadas que reporta la misma base de datos. Además, todas\r\nlas tecnologías son costeadas desde bases de aseguradores, para confirmación de precios. Resultados: Actualmente, el mercado se encuentra dominado por la electromiografía con electrodo de fibra única, la cual se encuentra dentro del plan de beneficios, pero por opinión de los realizadores, una vez que la prueba de acetilcolina receptores y de Lambert entre al plan de beneficios, se aumentará su participación, lo cual repercutirá en un ahorro al sistema, dado que dichas pruebas son menos costosas.(AU)
Assuntos
Humanos , Acetilcolina/análise , Anticorpos Bloqueadores/uso terapêutico , Edrofônio/análise , Eletromiografia/métodos , Miastenia Gravis/terapia , Reprodutibilidade dos Testes , Colômbia , Custos e Análise de Custo/métodos , Tecnologia Biomédica , EletrodosAssuntos
Miastenia Gravis Neonatal/diagnóstico , Miastenia Gravis Neonatal/tratamento farmacológico , Miastenia Gravis/diagnóstico , Inibidores da Colinesterase/uso terapêutico , Colinesterases/biossíntese , Edrofônio/uso terapêutico , Feminino , História do Século XX , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Miastenia Gravis Neonatal/mortalidade , Neonatologia/história , Neostigmina/uso terapêutico , Pediatria/história , Gravidez , Complicações na GravidezRESUMO
This commentary addresses some of the diverse questions of current interest with regard to the health effects of air pollution, including exposure-response relationships, toxicity of inhaled particles and risks to health, multipollutant mixtures, traffic-related pollution, accountability research, and issues with susceptibility and vulnerability. It considers the challenges posed to researchers as they attempt to provide useful evidence for policy-makers relevant to these issues. This commentary accompanies papers giving the results from the ESCALA project, a multi-city study in Latin America that has an overall goal of providing policy-relevant results. While progress has been made in improving air quality, driven by epidemiological evidence that air pollution is adversely affecting public health, the research questions have become more subtle and challenging as levels of air pollution dropped. More research is still needed, but also novel methods and approaches to address these new questions.
Este comentario aborda algunos de los temas de interés actual en relación con los efectos de la contaminación del aire sobre la salud, tales como las relaciones exposición-respuesta, la toxicidad y riesgos para la salud de las partículas inhaladas, las mezclas de contaminantes múltiples, la contaminación relacionada con el tráfico, la investigación sobre responsabilidad, y los problemas de susceptibilidad y vulnerabilidad. Considera los retos que se presentan a los investigadores que intentan proporcionar evidencia para los responsables políticos en estas cuestiones. Este texto acompaña otros trabajos con resultados del proyecto ESCALA, un estudio en varias ciudades de América Latina que tiene como objetivo general proporcionar resultados relevantes para la política pública. Aunque ha habido avances para mejorar la calidad del aire, gracias a la evidencia epidemiológica de que la contaminación aérea está afectando negativamente a la salud pública, las preguntas de investigación se han vuelto más sutiles y difíciles a medida que los niveles de contaminación se reducen. Se necesita más investigación, pero también nuevos métodos y enfoques capaces de enfrentar estas preguntas.
Assuntos
Animais , Camundongos , Colina/análogos & derivados , Junção Neuromuscular/metabolismo , Neurotransmissores/metabolismo , Pró-Fármacos/metabolismo , Colina/metabolismo , Inibidores da Colinesterase/farmacologia , Edrofônio/farmacologia , Estimulação Elétrica , /farmacologia , Metilaminas/farmacologia , Camundongos Endogâmicos , Neostigmina/farmacologia , Fármacos Neuromusculares Despolarizantes/farmacologia , Inibidores da Captação de Neurotransmissores/farmacologia , Piperidinas/farmacologia , Rana pipiensRESUMO
BACKGROUND: Traditional methods employed in esophageal investigation of patients with chest pain of undetermined origin includes upper endoscopy, esophageal manometry and pH monitoring. These methods many times disclose abnormalities that can only be enrolled as the possible cause of chest pain. Provocative tests can reproduce pain in the laboratory, establishing its esophageal origin. OBJECTIVES: Determine the positivity of acid perfusion test, edrophonium and balloon distension in patients with chest pain of undetermined origin and compare with results of traditional exams, establishing the gain for the diagnosis of esophageal pain. RESULTS: Forty patients with chest pain of undetermined origin (normal coronary angiography), 80% female, mean age of 54.7 years were submitted to traditional exams and provocative tests. Upper endoscopy disclosed erosive esophagitis in two (5%) and peptic ulcer in one (2.5%), esophageal manometry was abnormal in 60%. pH monitoring was abnormal in 14 (35%) with a positive symptom index in 7. Chest pain was considered of proved esophageal origin by traditional exams in 7 (17.5%) patients with a positive symptom index and of probable esophageal origin in 19 (47.5%) being 8 with gastroesophageal reflux disease and 11 abnormal esophageal motility. In 14 (35%) an esophageal origin could not be demonstrated. The acid perfusion test was positive in 10 (25%), edrophonium test in 8 (20%) and balloon distension test in 15 (37.5%) and at least one provocative test was positive in 23 (57.5%) patients. The introduction of provocative tests allowed the diagnosis of proved esophageal pain in 12 of 19 (63.1%) patients with probable esophageal pain and in 6 of 14 (42.8%) with normal or inconclusive traditional exams what represented a diagnostic gain of 45% (18/40). Two patients had negative provocative tests and a positive symptom index, making a total of 25 (62.5%) patients with proved esophageal pain.
Assuntos
Dor no Peito/diagnóstico , Doenças do Esôfago/diagnóstico , Adulto , Idoso , Dor no Peito/etiologia , Estudos Transversais , Diagnóstico Diferencial , Edrofônio , Doenças do Esôfago/complicações , Esofagoscopia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
RACIONAL: As dores de origem esofagiana e coronariana são bastante semelhantes do ponto de vista clínico, havendo necessidade de exclusão desta última, que ocasiona risco de morte. A investigação esofagiana tradicional de pacientes com dor torácica de origem indeterminada, envolve emprego de endoscopia digestiva alta, esofagomanometria e pHmetria esofagiana prolongada. Esses métodos, embora de grande importância diagnóstica, muitas vezes, revelam alterações, em sua maioria, potenciais para a origem da dor. Os testes provocativos de dor esofagiana, ao reproduzirem-na em laboratório, apontam com segurança a sua origem.OBJETIVOS: Determinar a positividade dos testes de perfusão ácida, do edrofônio e da distensão esofagiana com balão em pacientes com dor torácica de origem indeterminada, e correlacionar os resultados com os testes habitualmente empregados, estabelecendo o ganho no diagnóstico da dor esofagiana comprovada...
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor no Peito/diagnóstico , Doenças do Esôfago/diagnóstico , Estudos Transversais , Dor no Peito/etiologia , Diagnóstico Diferencial , Esofagoscopia , Edrofônio , Doenças do Esôfago/complicações , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Concentração de Íons de Hidrogênio , Manometria , Estudos ProspectivosRESUMO
The objective of this study is to determine the prevalence of esophageal disorders (ED) associated with recurrent chest pain (RCP) and the utility of esophageal functional tests (EFT) in the study of these patients. The cross-sectional study was conducted at Hospital Clínico de La Frontera, Chile. One hundred and twenty-three patients with RCP were studied using esophageal manometry, edrophonium stimulation and 24-h pH monitoring. The performance of EFT was considered acceptable when they were capable of finding ED. To state the probability that RCP had an esophageal origin, patients were classified according to whether their pain had a probable, possible or unlikely esophageal origin. The prevalence of ED was determined according to diagnoses obtained after applying EFT and a multivariate analysis was performed to examine the association between the esophageal origin of RCP and ED. Rates of correct diagnosis of 65.9%, 56.9% and 31.7% was verified for 24-h pH monitoring, esophageal manometry and edrophonium stimulation, respectively. In 38.2% of patients with RCP, the pain was probably of esophageal origin, in 42.3% there was a possible esophageal origin and in 19.5% an unlikely esophageal origin. A 44.7% prevalence of GERD, 26.8% of GERD with secondary esophageal motor dysfunction and 8.9% of pure esophageal motor dysfunction were verified. The multivariate analysis allowed us to verify the association between the probability of esophageal origin of RCP, the variables RCP duration, esophagitis and dysphagia coexistence (P= 0.037, P= 0.030 and P= 0.024, respectively), and a statistically significant association between ED and dysphagia coexistence (P= 0.028). A high prevalence of ED was identified in patients with RCP.
Assuntos
Dor no Peito/etiologia , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Edrofônio , Doenças do Esôfago/complicações , Esôfago/química , Esôfago/fisiologia , Esôfago/fisiopatologia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Monitorização Fisiológica , Análise Multivariada , Prevalência , RecidivaRESUMO
INTRODUCTION: Pathologic alterations in neuromuscular transmission, known as Myasthenia Gravis (MG), comprise combinations (forms) of pre- and post-synaptic changes whose age at onset and clinical manifestations are dissimilar. Some forms have autoimmune features, while others have a defect due to functional or structural plaque alternations. The purpose of this work is to describe the clinical forms of MG seen in childhood, to facilitate proper diagnosis and treatment. MATERIAL AND METHODS: Retrospective data from 87 patients studied at the Ricardo Gutierrez Children's Hospital from 1990 to 2002 are presented. They were evaluated by clinical, pharmacological, electrophysiological, laboratory and radiological exams. RESULTS: Three distinct groups of patients were found: Group 1, Transient Neonatal Myasthenia Gravis (TNMG) represented 6.8% 9 (n=6) of the total number of patients. None of these six patients had ocular involvement. Group 2, Congenital Myasthenia (CMG) represented 17.2% of cases 9 (n=15). These patients had an onset of symptoms from 1 to 12 months of age. Eight cases were sporadic and the remainder familial. The most frequent symptom in this group was bilateral blepharoptosis in 13 patients. Group 3, Juvenile Myasthenia (JMG) comprised 76% of the patients (n=66). The onset of symptoms in this group ranged from 13 months to 14 years (mean 3.6 years). Thirty-nine of these children presented purely with ocular symptoms. CONCLUSIONS: Children with myasthenia gravis may present to the ophthalmologist first, with symptoms such as unilateral or bilateral blepharoptosis, diplopia, strabismus or ophthalmoplegia. Therefore, it is essential that the ophthalmologist be aware of the varied features of this disorder in children in order to diagnosis it correctly and make appropriate treatment referrals.
Assuntos
Miastenia Gravis/diagnóstico , Adulto , Idade de Início , Blefaroptose/diagnóstico , Criança , Pré-Escolar , Inibidores da Colinesterase , Técnicas de Diagnóstico Oftalmológico , Diplopia/diagnóstico , Edrofônio , Eletrofisiologia/métodos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Miastenia Gravis/classificação , Miastenia Gravis/terapia , Oftalmoplegia/diagnóstico , Estudos Retrospectivos , Estrabismo/diagnósticoRESUMO
OBJECTIVE: To identify the response to thymectomy in patients with seronegative and seropositive myasthenia gravis (SPMG). We analyzed the associated diseases, thymus histology, and the severity of symptoms between the two groups. MATERIAL AND METHODS - DESIGN: Descriptive, comparative. STUDY UNITS: Fourteen patients with seronegative myasthenia gravis (SNMG) and 57 patients with SPMG who had a thymectomy between 1987 and 1997, with at least 3 years of follow-up. The patients were divided into four groups; (1) Remission, (2) Improvement, (3) No change and (4) Deterioration. RESULTS: Fourteen patients (20%) were seronegative and 57 were seropositive (80%). In the group of patients with SNMG, three patients were in remission (21%), five with improvement (36%), five with no change (36%) and one with worsening (7%). In the group of patients with SPMG, 12 were in remission (21%), 17 with improvement (30%), 25 with no change (44%) and three (5%) with worsening. The patients with SNMG were older, with less associated diseases and with a lower frequency of thymomas. CONCLUSIONS: The response to thymectomy was similar between the two groups. It has been suggested that seronegative patients have a better prognosis, but our results show no differences.
Assuntos
Autoanticorpos/sangue , Miastenia Gravis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Receptores Colinérgicos/imunologia , Timectomia , Timoma/cirurgia , Hiperplasia do Timo/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Progressão da Doença , Edrofônio , Eletromiografia , Feminino , Seguimentos , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/imunologia , Miastenia Gravis/patologia , Exame Neurológico , Timoma/imunologia , Timoma/patologia , Hiperplasia do Timo/imunologia , Hiperplasia do Timo/patologia , Neoplasias do Timo/imunologia , Neoplasias do Timo/patologia , Resultado do TratamentoRESUMO
Acetylcholinesterase (AChE) molecular forms were studied during mouse brain development. Mouse embryos expressed a monomeric (G1) and a tetrameric (G4) AChE form. Our results indicate that G4 AChE expressed at embryonic day (ED) 9 and ED15 could be purified by acridinium-Sepharose chromatography and shared similar biochemical and kinetic properties with the adult form. However, the G1 form expressed at either embryonic stage did not bind to acridinium, was not inhibited by excess substrate, and possessed higher K(m) and lower Vmax values than the adult G1 form. Two peripheral anionic binding site inhibitors, fasciculin and propidium, had a significantly lower affinity for the monomeric form at ED9. Results are discussed in terms of the biological significance of the embryonic G1 form, and its resemblance to the AChE activity found, associated with the senile plaques present in the brains of Alzheimer's patients.