IntroducciónLos pacientes con déficits inmunológicos están predispuestos a enfermedad pulmonar por causas infecciosas y no infecciosas que dan cuadros clínicos y radiológicos superponíales (tabla I), lo cual no es razón para añadir sistemáticamente agentes antimicrobianos al régimen terapéutico del paciente, sino que, más bien, exige un estudio diagnóstico precoz y a veces agresivo para iniciar un tratamiento específico y evitar los efectos secundarios y de superinfección por antibióticos innecesarios o inadecuados 1 .El procedimiento diagnóstico de elección en el huésped inmunocomprometido (HIC) con nueva afectación pulmonar vendrá dado por: 7) la situación clínica del paciente, 2) sospecha diagnóstica, J) fiabilidad y complicaciones del procedimiento elegido y 4) posibilidades materiales del centro hospitalario. La fibrobroncoscopia (FB), con las diversas posibilidades de recogida de material para estudio citológico, microbiológico e histológico, se muestra actualmente como uno de los mejores métodos diagnósticos invasivos a emplear inicialmente en el HIC con afectación pulmonar. Métodos diagnósticosLa etiología más frecuente de los nuevos infiltrados pulmonares en el HIC es la infecciosa, a la vez que la más potencialmente curable. El diagnóstico etiológico TABLA I Principales causas de infiltrados pulmonares en el huésped inmunocomprometido Infecciones Infiltrados neoplásicos Radioterapia Neumonitis por fármacos Hemorragia pulmonar Edema pulmonar Cardiogénico No cardiogénico Enfermedad tromboembólica Reacciones post-transfusionales Neumonitis inflamatoria Idiopática o inespecíficapreciso es particularmente complejo en pacientes hospitalizados, debido a que sus vías aéreas son rápidamente colonizadas por gran variedad de organismos potencialmente patógenos. Además, el clínico debe considerar la posibilidad de infecciones no bacterianas, especialmente frecuentes en este tipo de enfermos; en este contexto, los métodos bacteriológicos tradicionales aportan generalmente información confusa. Criterios clínicosPueden tener valor en enfermos sin inmunosupresión, pero en el HIC suelen ser poco específicos, dando lugar a abundantes errores diagnósticos. Material obtenido de esputo o de secreciones traqueobronquialesRara vez es adecuado para el cultivo, especialmente por la contaminación del mismo por organismos que colonizan las vías aéreas superiores 2 ' 3 . De igual forma, esta contaminación dificulta la interpretación del Gram, existiendo poca correlación entre los organismos vistos en la tinción de Gram y los que posteriormente crecen en cultivo; por tanto, la proporción de falsos positivos y negativos es alta 4 ' 5 . Cultivos sanguíneosEn pacientes con neumonía pueden aportar un diagnóstico etiológico preciso; sin embargo, sólo de un 15 % a un 25 % de pacientes con neumonía neumocócica tienen hemocultivos positivos y la cifra desciende bastante con otros gérmenes, aún más habituales en el HIC 6 . En el individuo neutropénico son de gran ayuda, ya que en muchos casos pueden ser positivos antes de que se objetiven a...
congested and targeted oncology indication, majority of agents are in phase II/III clinical development. To evaluate pipeline drugs and focus on its improving outcomes, which will provide benefit to largest drug treatable population in NSCLC, a research is being conducted to demonstrate which class of drug will provide best result to improve the patient condition suffering from NSCLC. Method: To draw insight for research, data covered from clinicaltrail.gov (NSCLC pipeline agents at various stages of development), compared therapeutic assessments by molecule type, monotherapy and combination products, route of administration, publically available CMS data, company's websites, investor presentations, and SEC filings and featured press releases from companies and also including news to track the most recent updates. Result: PD-1 Inhibitors (Immune checkpoint inhibitors), epidermal growth factor receptor (EGFR) antagonists -tyrosine kinase inhibitors (TKIs) and anaplastic lymphoma kinase (ALK) inhibitors classes of pipeline drugs are studied and analyzed. PD-1 inhibitors and EGFR-inhibitors drugs showed positive clinical outcomes and have probability to cover by major formularies. Conusion: Drugs that succeed in providing even incremental survival benefits could be very successful commercially in NSCLC indication. The market for EGFR inhibitors will be more lucrative followed by PD-1 inhibitors. After, the expected launch of drugs that are in pipeline will provide better option for oncologist to suggest best therapies for patients suffering from NSCLC. Further, by demonstrating positive clinical outcomes and cost effectiveness of pipeline drugs, faster formulary placement of molecules can be attained.
A199 simple random sample of 46 patients distributed throughout the country to develop validation of measuring instruments : (i) Fact-Lym scale, (ii) Facit-fatigue scale. As a comparison scale items, was applied a vision analogous scale (VAS), wich assessed the homogeneity of the questions by averaging all correlations between all items to see effectively will be consistent. Translations of the instruments were not needed as these are in Spanish language. Results: From a total of 46 respondents, 2.17% was not able to answer. Through each having dimensions of the scales, Cronbach's alpha coefficient was estimated using the results of the VAS, obtaining a 84.19 alpha coefficient for overall fitness, 87.00 for family and social environment, 64.3 for emotional state, personal functioning 78.17, other concerns 90.82 and to the level of fatigue 92.53. Results suggest high levels of reliability above 75% (except the dimension of emotional state) of the scales and the results obtained through this. ConClusions: There is a strong correlation between the scores of the items of the Fact-Lym and Facit-fatigue scale regarding the estimate of Cronbach's alpha coefficient, thereby it's considered reliable for use in patients with myeloproliferative syndromes in Colombia.
Among other factors, the breakdown of skeletal muscle fibers (rhabdomyolysis) is a leading cause of acute kidney failure. While rhabdomyolysis is multi-
Giving to the burden disease evaluated by Peñaloza et al. (2014), in Colombia the major depressive disorder represented the second disease with most DALYs for both genders in all age groups. Due to this result we decided to determine the economic cost of major depressive disorder in Colombia from the third-payer and patient perspectives for year 2011. MethOds: We used the official SISPRO data to get information regarding the number of visits per patient who had a diagnosis of major depressive disorder. To calculate the monetary costs, we assumed that a treatment was provided to every patient reported on the system according to the study of Pinto et al. (2010) and from the SOAT fare manual 2011 reported by the government. We multiplied the treatment cost for each patient by the total number of registers to obtain the third-payer cost. We calculated from the patient´s perspective the lost output as a result of a reduction of productivity due to major depressive disorder, using the DALYs adjusted by life expectancy, multiplied by the 2011 current GDP divided by the working-age population. Results: The total Economic impact for 2011 was USD 454.955.680. This is the result of adding the third-payer cost of USD 449.338.332 plus the patient cost of USD 5.617.347. cOnclusiOns: With this approximation to the economic impact of the major depressive disorder the government can design cost-effective mental health policies to reduce its prevalence for Colombia's population, especially for women. The cost of major depressive disorder represents 0.14% of 2011 current GDP, this means that on average there is an expenditure of USD 9.88 for each Colombian citizen to prevent the disease. Those numbers shows the importance to generate permanent public policies to improve the Colombians´ mental health.
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