No abstract

No abstract

The interest on Multicriteria decision analysis (MCDA) for healthcare priority setting has grown in popularity in the last few years. Literature shows several exercises where MCDA can be used to inform different types of priorities; however, there is little evidence on the feasibility of implementing this method in current institutionalized decision-making processes. We examined the willingness to implement MCDA as a tool to facilitate decision-making in Central America and the Caribbean (CAC). We convene 41 representatives of the healthcare public sector from 10 countries to explore whether they consider MCDA a robust tool to be incorporated in local priority setting processes and which ongoing decision-making process could be benefited from this methodology. We developed a 2-days hands-on training course to explain the technique, advantages and limitations. The group achieved a broad consensus that MCDA can be used in CAC to help priority setting processes because it introduces transparency, facilitates the implementation of a systematic process and is relatively easy to explain to many stakeholders. It was acknowledged that MCDA can be used to inform decisions about coverage, though a major opportunity was identified to help informing other decisions, such as priorities for joint purchasing and the elaboration of national plans.

Introduction: It is estimated that 2000 snakebites occur in Panama every year, 70% of which are inflicted by B. asper. Objective: To determine the biochemical and toxicologic effects and to assess the immunochemical characteristics of the reference B. asper venom experimentally used in this work. Methods: The venom was prepared as a homogeneous mixture of the venoms obtained from 78 adult specimens of this species collected in four geographic areas of Panama. Enzymatic and toxicologic activities were assayed following the specific methodologies of each experiment. SDS-PAGE (15% gel) was carried out under reducing conditions. Subsequently, Western blotting was performed. Results: It was found that this venom has lethal, hemorrhagic, myotoxic, edema-forming, coagulant, defibrinating, proteinase and phospholipase A2 activities. SDS-PAGE (15%) showed the presence in this venom of protein bands with molecular weights ranging from 8 to 70kDa, with the presence of predominant bands at ≈ 15kDa and ≈ 30 to 66kDa, which probably correspond to phospholipases A2 (the former) and metalloproteinases (the latter), respectively. Through immunoblotting, a high degree of recognition by various antivenoms was observed, mainly from Colombian and Costa Rican antivenoms. Conclusion: This B. asper reference venom will be highly useful for the preclinical evaluation of antivenoms.

No abstract