Sostenibilidad del Gasto Público: cobertura y financiamiento de enfermedades crónicas en México (Public spending sustainability: Coverage and financing of chronic diseases in Mexico)

Abstract This article analyzes the sustainability of public health expenditures from the cost perspective of the principle chronic diseases that the Mexican population suffers and the Mexican Government would finance. Also, it pretends to contribute to the discussion of universal effective health coverage in Mexico by providing a micro simulation tool which would evaluate different scenarios about financial costs of universal coverage. As a result, fiscally sustainable proposals can be made based on this micro simulation tool that consider the demographic and epidemiological changes that translate into costs increases. Resumen Este artículo analiza la sostenibilidad del gasto público en salud, desde la perspectiva del costo de las principales enfermedades crónicas que padece la población mexicana, y que debe cubrir el gobierno federal. Asimismo, pretende abrir la discusión sobre la cobertura efectiva universal de salud en México, a través de una herramienta de microsimulación que permita presentar y evaluar diferentes escenarios en cuanto a su costo financiero, para poder hacer propuestas de financiamiento sostenible, principalmente porque se están enfrentando cambios demográficos y epidemiológicos que conllevan aumentos en los costos de atención médica

Médula anclada. Presentación de caso / Tethered Cord Syndrome. A case report

Se presenta un caso con el diagnóstico de médula anclada atendido en el servicio de Neurocirugía del Hospital "Mario Catarino Rivas" en San Pedro Sula, Honduras, en el año 2009. Paciente femenina, de 22 años de edad, con antecedentes de salud, que presentó un cuadro de retención urinaria de dos años de evolución. Se le diagnostica médula anclada y es operada con resultados satisfactorios. Es una patología poco frecuente en el adulto y hasta el momento se registra un aproximado de 60 casos reportados.Palabras clave: MÉDULA ESPINAL/anomalías, MENINGOMIELOCELE.ABSTRACTA case presenting the diagnosis of Tethered Cord Syndrome was assisted at "Mario Catarino Rivas" Hospital in the Service of Neurosurgery, San Pedro Sula, Honduras-2009. A 22 year-old female patient with health records presented urinary retention of two years of natural history. Tethered cord syndrome was diagnosed and the patient underwent a surgery with satisfactory results; this is a rare pathology in adults with only 60 cases reported at present.Key words: SPINAL CORD/abnormalities, MENINGOMYELOCELE

Médula anclada. Presentación de caso / Tethered Cord Syndrome. A case report

Se presenta un caso con el diagnóstico de médula anclada atendido en el servicio de Neurocirugía del Hospital "Mario Catarino Rivas" en San Pedro Sula, Honduras, en el año 2009. Paciente femenina, de 22 años de edad, con antecedentes de salud, que presentó un cuadro de retención urinaria de dos años de evolución. Se le diagnostica médula anclada y es operada con resultados satisfactorios. Es una patología poco frecuente en el adulto y hasta el momento se registra un aproximado de 60 casos reportados.Palabras clave: MÉDULA ESPINAL/anomalías, MENINGOMIELOCELE.ABSTRACTA case presenting the diagnosis of Tethered Cord Syndrome was assisted at "Mario Catarino Rivas" Hospital in the Service of Neurosurgery, San Pedro Sula, Honduras-2009. A 22 year-old female patient with health records presented urinary retention of two years of natural history. Tethered cord syndrome was diagnosed and the patient underwent a surgery with satisfactory results; this is a rare pathology in adults with only 60 cases reported at present.Key words: SPINAL CORD/abnormalities, MENINGOMYELOCELE

Impacto de la modalidad de carga de fluidos en el diagnóstico de la capacidad de respuesta a volumen

El objetivo de este estudio fue describir la “carga de volumen” y evaluar la diferencia en la proporción de "respondedores" (PR) según el tipo de fluido, el volumen, la duración de la infusión y el momento de la evaluación. Métodos: Se realizaron búsquedas en MEDLINE y Embase para estudios que utilizan la carga de volumen como una prueba de precarga cardíaca con una descripción de la técnica, una definición reportada de capacidad de respuesta de fluidos y PR. El resultado primario fue la PR media, según el volumen de líquido, el tipo de líquidos, la tasa de infusión y el tiempo de evaluación. Resultados: se incluyeron un total de 85 estudios (3601 pacientes) en el análisis. Las PR fueron 54.4% (IC 95% 46.9-62.7) donde se administró 500 ml fue administrado (p = 0.71). El PR no se vio afectado por el tipo de fluido. La RP fue similar entre los pacientes a los que se administró una carga de volumen durante 10 minutos después de la exposición a los fluidos. Las proporciones de respondedores fueron 53.9%, 57.7% y 52.3%, respectivamente (p = 0.47). Conclusiones: el PR disminuye con un tiempo de infusión largo. Es deseable estandarizar la carga de volumen. Abstract The purpose of this study was to describe the ‘charge of volume’ and evaluate the difference in proper proportion for ‘responders’ (PR) according the type of liquid, volume, the timing of infusion and the moment of evaluation. Methods: Medline and Embase searches were made for studies using charge of volumen as a cardiac precharge test among a technique description, fluid  response capacities reported definition and PR. Primary results were average PR, according liquid volumen, liquid type, infusion ratio and time for evaluation. Results: A total of 85 studies (3,601 patients) for the analysis. PR were 54.4% (IC 95% 46.9-62.7) where 500 ml was administrated (p=0.71). PR was not influenced by the type of fluid. RP was similar among patients given a charge of volumen during <15 minutes  (59.2%, IC 95% 54.2-64.1) and during 15-30 minutes (57.7%, IC 95% 52.4-62.4, p = 1). In time of infusion ≥30 minutes, a lesser 49.9% (IC 95% 45.6-54, p = 0.04) PR happened. Response was evaluated at the end of fluid exposure between 1 and 10 minutes, and <10 minutes after fluid exposure. Responder´s proportion was 53.9%, 57.7% y 52.3% (p=0.47). Findings: PR decreases in a long infusion time.  Standardise charge of volumen is desirable

Impacto de la modalidad de carga de fluidos en el diagnóstico de la capacidad de respuesta a volumen

The purpose of this study was to describe the ‘charge of volume’ and evaluate the difference in proper proportion for ‘responders’ (PR) according the type of liquid, volume, the timing of infusion and the moment of evaluation. Methods: Medline and Embase searches were made for studies using charge of volumen as a cardiac precharge test among a technique description, fluid  response capacities reported definition and PR. Primary results were average PR, according liquid volumen, liquid type, infusion ratio and time for evaluation. Results: A total of 85 studies (3,601 patients) for the analysis. PR were 54.4% (IC 95% 46.9-62.7) where &lt;500 ml was administrated 57.2% (IC 95% 52.9-61.0) where 500 ml was administrated and 60.5% (IC 95% 35.9-79.2) where &gt;500 ml was administrated (p=0.71). PR was not influenced by the type of fluid. RP was similar among patients given a charge of volumen during &lt;15 minutes  (59.2%, IC 95% 54.2-64.1) and during 15-30 minutes (57.7%, IC 95% 52.4-62.4, p = 1). In time of infusion ≥30 minutes, a lesser 49.9% (IC 95% 45.6-54, p = 0.04) PR happened. Response was evaluated at the end of fluid exposure between 1 and 10 minutes, and &lt;10 minutes after fluid exposure. Responder´s proportion was 53.9%, 57.7% y 52.3% (p=0.47). Findings: PR decreases in a long infusion time.  Standardise charge of volumen is desirable.El objetivo de este estudio fue describir la “carga de volumen” y evaluar la diferencia en la proporción de "respondedores" (PR) según el tipo de fluido, el volumen, la duración de la infusión y el momento de la evaluación. Métodos: Se realizaron búsquedas en MEDLINE y Embase para estudios que utilizan la carga de volumen como una prueba de precarga cardíaca con una descripción de la técnica, una definición reportada de capacidad de respuesta de fluidos y PR. El resultado primario fue la PR media, según el volumen de líquido, el tipo de líquidos, la tasa de infusión y el tiempo de evaluación. Resultados: se incluyeron un total de 85 estudios (3601 pacientes) en el análisis. Las PR fueron 54.4% (IC 95% 46.9-62.7) donde se administró &lt;500 ml, 57.2% (IC 95% 52.9-61.0) donde se administraron 500 ml y 60.5% (IC 95% 35.9-79.2) donde&gt; 500 ml fue administrado (p = 0.71). El PR no se vio afectado por el tipo de fluido. La RP fue similar entre los pacientes a los que se administró una carga de volumen durante &lt;15 minutos (59.2%, IC 95% 54.2-64.1) y durante 15-30 minutos (57.7%, IC 95% 52.4-62.4, p = 1). Cuando el tiempo de infusión fue ≥30 minutos, hubo una PR menor de 49.9% (IC 95% 45.6-54, p = 0.04). La respuesta se evaluó al final de la exposición a los fluidos, entre 1 y 10 minutos, y &gt; 10 minutos después de la exposición a los fluidos. Las proporciones de respondedores fueron 53.9%, 57.7% y 52.3%, respectivamente (p = 0.47). Conclusiones: el PR disminuye con un tiempo de infusión largo. Es deseable estandarizar la carga de volumen

Preliminary report on the July 10–11, 2015 explosive eruption at Volcán de Colima: Pyroclastic density currents with exceptional runouts and volume

http://dx.doi.org/10.1016/j.jvolgeores.2015.11.022Reporte preliminar acerca de una de las últimas etapas eruptivas de Volcán de Colima, análisis realizado a partir de técnicas de percepción remotaOn July 10–11, 2015 an eruption occurred at Colima volcano produced 10.5 km long pyroclastic density currents (PDCs) along the Montegrande, and 6.5 km long along the San Antonio ravines. The summit dome was destroyed and a new crater excavated and breached to the south. This new breach connects to a narrow channel that descends along Colima's southern flank and was used by a subsequent lava flow. The Montegrande PDCs represent the longest and hottest flow of this type recorded during the past 30 years but are still smaller in comparison to the 15-km long PDCs produced during the 1913 Plinian eruption. Data obtained from field reconnaissance, lahar monitoring stations, and satellite imagery suggest that at least six PDCs occurred. The two largest PDCs (H/L 0.2) were able to surmount topographic barriers or bends. Based on field reconnaissance and digital elevation models extracted from SPOT satellite imageries we estimate a minimum volume for the valley-pond and distal fan deposits of 4.5 × 106 m3. After one week, the deposits were still hot with burning trees on the surface and millimeter-sized holes from which fumes were emanating. The juvenile components of the deposits consist of gray dense blocks and vesicular dark-gray blocks and bombs with bread-crust textures and cooling joints. The mineral association of these rocks consists of plagioclase + clinopyroxene + orthopyroxene + FeTi-oxides ± olivine and resorbed hornblende in a dark glassy matrix that corresponds to an andesitic composition.CONACY

Effects of Curcumin on the Proliferation and Mineralization of Human Osteoblast-Like Cells: Implications of Nitric Oxide

Curcumin (diferuloylmethane) is found in the rhizomes of the turmeric plant (Curcuma longa L.) and has been used for centuries as a dietary spice and as a traditional Indian medicine used to treat different conditions. At the cellular level, curcumin modulates important molecular targets: transcription factors, enzymes, cell cycle proteins, cytokines, receptors and cell surface adhesion molecules. Because many of the curcumin targets mentioned above participate in the regulation of bone remodeling, curcumin may affect the skeletal system. Nitric oxide (NO) is a gaseous molecule generated from L-arginine during the catalization of nitric oxide synthase (NOS), and it plays crucial roles in catalization and in the nervous, cardiovascular and immune systems. Human osteoblasts have been shown to express NOS isoforms, and the exact mechanism(s) by which NO regulates bone formation remain unclear. Curcumin has been widely described to inhibit inducible nitric oxide synthase expression and nitric oxide production, at least in part via direct interference in NF-κB activation. In the present study, after exposure of human osteoblast-like cells (MG-63), we have observed that curcumin abrogated inducible NOS expression and decreased NO levels, inhibiting also cell prolifieration. This effect was prevented by the NO donor sodium nitroprusside. Under osteogenic conditions, curcumin also decreased the level of mineralization. Our results indicate that NO plays a role in the osteoblastic profile of MG-63 cells

Vascular Inflammation in Subclinical Atherosclerosis Detected by Hybrid PET/MRI

BACKGROUND: Atherosclerosis is a chronic inflammatory disease, but data on arterial inflammation at early stages is limited. OBJECTIVES: The purpose of this study was to characterize vascular inflammation by hybrid 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI). METHODS: Carotid, aortic, and ilio-femoral 18F-FDG PET/MRI was performed in 755 individuals (age 40 to 54 years; 83.7% men) with known plaques detected by 2-/3-dimensional vascular ultrasound and/or coronary calcification in the PESA (Progression of Early Subclinical Atherosclerosis) study. The authors evaluated the presence, distribution, and number of arterial inflammatory foci (increased 18F-FDG uptake) and plaques with or without inflammation (coincident 18F-FDG uptake). RESULTS: Arterial inflammation was present in 48.2% of individuals (24.4% femorals, 19.3% aorta, 15.8% carotids, and 9.3% iliacs) and plaques in 90.1% (73.9% femorals, 55.8% iliacs, and 53.1% carotids). 18F-FDG arterial uptakes and plaques significantly increased with cardiovascular risk factors (p < 0.01). Coincident 18F-FDG uptakes were present in 287 of 2,605 (11%) plaques, and most uptakes were detected in plaque-free arterial segments (459 of 746; 61.5%). Plaque burden, defined by plaque presence, number, and volume, was significantly higher in individuals with arterial inflammation than in those without (p < 0.01). The number of plaques and 18F-FDG uptakes showed a positive albeit weak correlation (r = 0.25; p < 0.001). CONCLUSIONS: Arterial inflammation is highly prevalent in middle-aged individuals with known subclinical atherosclerosis. Large-scale multiterritorial PET/MRI allows characterization of atherosclerosis-related arterial inflammation and demonstrates 18F-FDG uptake in plaque-free arterial segments and, less frequently, within plaques. These findings suggest an arterial inflammatory state at early stages of atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).The PESA study is cofunded equally by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and Banco Santander. The study also receives funding from the Instituto de Salud Carlos III (PI15/02019) and the European Regional Development Fund (ERDF) “A way to make Europe.” The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades, and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Dr. Sanchez-González is an employee of Philips Healthcare. Dr. Bueno has received research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 & PI17/01799), AstraZeneca, Bristol-Myers Squibb, Janssen, and Novartis; has received consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and Novartis; and has received speaking fees or support for attending scientific meetings from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Novartis, and MEDSCAPE-the heart.org.S

Patients with Cholangiocarcinoma Present Specific RNA Profiles in Serum and Urine Extracellular Vesicles Mirroring the Tumor Expression: Novel Liquid Biopsy Biomarkers for Disease Diagnosis

Cholangiocarcinoma (CCA) comprises a group of heterogeneous biliary cancers with dismal prognosis. The etiologies of most CCAs are unknown, but primary sclerosing cholangitis (PSC) is a risk factor. Non-invasive diagnosis of CCA is challenging and accurate biomarkers are lacking. We aimed to characterize the transcriptomic profile of serum and urine extracellular vesicles (EVs) from patients with CCA, PSC, ulcerative colitis (UC), and healthy individuals. Serum and urine EVs were isolated by serial ultracentrifugations and characterized by nanoparticle tracking analysis, transmission electron microscopy, and immunoblotting. EVs transcriptome was determined by Illumina gene expression array [messenger RNAs (mRNA) and non-coding RNAs (ncRNAs)]. Differential RNA profiles were found in serum and urine EVs from patients with CCA compared to control groups (disease and healthy), showing high diagnostic capacity. The comparison of the mRNA profiles of serum or urine EVs from patients with CCA with the transcriptome of tumor tissues from two cohorts of patients, CCA cells in vitro, and CCA cellsderived EVs, identified 105 and 39 commonly-altered transcripts, respectively. Gene ontology analysis indicated that most commonly-altered mRNAs participate in carcinogenic steps. Overall, patients with CCA present specific RNA profiles in EVs mirroring the tumor, and constituting novel promising liquid biopsy biomarkers