Cost-efficacy of remissive drugs and a control problem of rheumatoid arthritis in patients living in the highlands

De un total de 322 pacientes con Artritis Reumatoide (AR) evaluados en este periodo en nuestro hospital, 50 pacientes con diagnóstico definitivo de AR, que radican en altura, fueron incluidos en un estudio prospectivo, longitudinal, comparativo y experimental, para valorar en un seguimiento mínimo de 6 meses, el costo-eficacia de bajas dosis de metotrexato (MTX), versus aureotiomalato de sodio (AUTS). Fueron randomizados: grupo MTX 30 pacientes que recibieron la droga (promedio 7.5 mg/sem V O), grupo A UTS 20 pacientes que recibieron un promedio de 50 mg/sem 1M, luego de dosis iniciales de 10-25 mg/sem. Ambos grupos presentaron una mejora clínica evidente, valorados con los índices de actividad, factores pron6sticos y puntaje de severidad propuestos por Wilke y Clough modificados. En el grupo MT X: score inicial de actividad 7.4 y final de 1.8. En el grupo AUTS score inicial 7.2, final 2.0. El puntaje de severidad para el grupo MTX inicial 11.4 y final 3.8; para A UTS inicial 11.2 y final 4.0. La eficacia de ambas drogas remisivas fue similar a los 6 meses de la evaluaci6n inicial (p>0.05). Sin embargo, se encontró diferencias amplias en el costo unitario $527 pac/año para AUTS versus$ 18 pac/año para M TX, concluyéndose que el MTX es 29 veces más econ6mico que AUT S, conservando ambos la misma eficacia, por lo que se justifica su primera elecci6n como droga remisiva en AR de altura, dentro del desarrollo de un Programa de Control Preventivo Promocional de AR que proponemos.From a total of 322 patients with Rheumatoid Arthritis (RA) who were assessed in this period in our hospital, 50 patients with definite diagnosis of RA who live in the highlands, were included in a prospective, longitudinal, comparative and experimental study, in order to assess in a minimal 6-month follow-up the cost-efficacy of low doses of metotrexate (MTX), versus sodium aureothiomalate (SAUT). The randomized groups were as follows: MTX group, 30 patients who received the drug (average of 7,5 mg/sem VO), SAUT group, 20 patients who patients an average of 50 mg/sem IM, after initial doses of 10-25 mg/sem. Both groups showed a clear clinical improvement, assessed through modified activity rates, prognosis factors and severity score proposed by Wilke and Clough. For the group MTX, the initial activity score was 7,4 and the final one 1,8. For the SAUT group, the initial score was 7,2 and the final one 2,0. The initial severity score for the MTX group was 11,4 and the final one 3,8; for the SAUT group, the initial one was 11,2 and final one 4,0. The efficacy of both remissive drugs was similar trough the 6 months of the initial evaluation (p>0,05). However, considerable differences were found in the unitary cost: $527 pac/year for SAUT versus$ 18 pac/year for MTX, concluding that the MTX is 29 times more economical than the SAUT, both keeping the same effectiveness. This justifies its first election as remissive drug for high-land RA, within the development of a Preventive-Promotional Control Program for RA that is being proposed

How is the ultrasound in rheumatology used, implemented, and applied in Latin American centers? Results from a multicenter study

This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren’s syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management. © 2016, International League of Associations for Rheumatology (ILAR)

How is the ultrasound in rheumatology used, implemented, and applied in Latin American centers? Results from a multicenter study

This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren’s syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management. © 2016, International League of Associations for Rheumatology (ILAR)

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease