1
|
Alcaraz A, Adedeji A, Pichón-Riviere A, Amara Ekeruche M, Casarini A, Rodríguez Cairoli F, Espinola N, Roberti J, Palacios A, Bardach A. Estimating the Effectiveness of Health Warnings on Cigarette Packaging in Nigeria: A Modeling Study. Nicotine Tob Res 2023; 25:1736-1743. [PMID: 37262432 DOI: 10.1093/ntr/ntad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Tobacco consumption is associated with nearly 30 000 deaths annually in Nigeria alongside other adverse health and economic effects. Our objective was to estimate the health and economic implications of the current cigarette labeling policies (text-only HWs); new health warnings policies in the country (adding graphic health warnings with up to 60% coverage), and plain packaging policy as recommended by the World Health Organization. AIMS AND METHODS We used a probabilistic state-transition individual microsimulation model, considering natural history, healthcare costs, and quality-of-life losses associated with main tobacco-attributable diseases; and the potential effects of packaging and labeling policies. We used three scenarios: (1) text-only health warnings (HWs) covering 50% of the pack, (2) introduction of graphic HWs of 50% (and later increasing to 80%) of the pack, and (3) plain packaging with HWs covering 80% of the pack. RESULTS A total of 748 deaths are averted in the current situation; 7478 and 14 208 deaths can be averted with the new policy and with plain packaging, respectively. The number of cardiac, cerebrovascular, and cancer events that could be averted by adopting text and graphic HWs are 3093, 5093, and 1346, respectively; increasing to 5876, 9676, and 2557, respectively, with plain packaging. Up to 251 794 years were lost because of early deaths and disability, and ₦144.6 billion (USD 469 million) in health costs could be saved with HWs covering 50% to 80% of the pack over 10 years. With plain packaging and graphic HWs covering 80% of the package 478,408 years and ₦274.7 billion (USD 895 million) would be saved. CONCLUSIONS The new cigarette labeling policy in Nigeria may yield significant health and economic benefits over 10 years. Moving the current policy to plain packaging can significantly improve these benefits. IMPLICATIONS The new cigarette labeling policy that Nigeria is implementing should aim to achieve 100% compliance with its current regulation and the logical next step: Plain packaging with large warnings. The present study adds evidence of the potential health effects and cost savings of these levels of implementation, which is valuable for local policymakers.
Collapse
Affiliation(s)
- Andrea Alcaraz
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Adeniran Adedeji
- Macroeconomics and Public Financial Management, Center for the Study of the Economies of Africa, Abuja, Nigeria
| | - Andrés Pichón-Riviere
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| | - Mma Amara Ekeruche
- Macroeconomics and Public Financial Management, Center for the Study of the Economies of Africa, Abuja, Nigeria
| | - Agustín Casarini
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Natalia Espinola
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| | - Alfredo Palacios
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| |
Collapse
|
2
|
Pichon-Riviere A, Bardach A, Rodríguez Cairoli F, Casarini A, Espinola N, Perelli L, Reynales-Shigematsu LM, Llorente B, Pinto M, Saenz De Miera Juárez B, Villacres T, Peña Torres E, Amador N, Loza C, Castillo-Riquelme M, Roberti J, Augustovski F, Alcaraz A, Palacios A. Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study. Tob Control 2023:tc-2022-057618. [PMID: 37142423 DOI: 10.1136/tc-2022-057618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.
Collapse
Affiliation(s)
- Andrés Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- CIESP, CONICET, Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- CIESP, CONICET, Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Agustín Casarini
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Natalia Espinola
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Tatiana Villacres
- Health Economics, Pontificia Universidad Católica del Ecuador, Quito, Pichincha, Ecuador
| | | | | | - César Loza
- Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| |
Collapse
|
3
|
Bardach AE, Espínola N, Cairoli FR, Perelli L, Balan D, Palacios A, Augustovski F, Pichón-Riviere A, Alcaraz AO. The burden of disease and economic impact of sugar-sweetened beverages' consumption in Argentina: A modeling study. PLoS One 2023; 18:e0279978. [PMID: 36821592 PMCID: PMC9949658 DOI: 10.1371/journal.pone.0279978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Approximately two-thirds of Argentine adults are overweight or obese, and 11% have diabetes. Over the last two decades, all population groups have increased their consumption of ultra-processed foods and sugar-sweetened beverages (SSB). We aimed to estimate the disease burden-deaths, events, and costs to the health system-attributed to SSB consumption in Argentina. METHODS We used a comparative risk assessment framework to estimate the health and economic impacts that would be avoided in a scenario without sugar-sweetened beverage (SSB) consumption. We calculated the direct effects on diabetes, cardiovascular disease, and BMI, and then estimated the effects of BMI on disease incidence. Finally, we applied the population attributable factor to calculate the health and economic burden avoided in Argentina in 2020. RESULTS Our model estimated that about 4,425 deaths, 110,000 healthy life years lost to premature death and disability, more than 520,000 cases of overweight and obesity in adults, and 774,000 in children and adolescents would be attributed to SSB Consumption in Argentina. This disease burden corresponds to 23% of type-2 diabetes cases and other significant proportions of cardiovascular disease and cancer. The overweight and obesity costs attributable to SSB totaled approximately $47 million in adults and $15 million in children and adolescents. CONCLUSION A significant number of disease cases, deaths, and health care costs could be attributed to SSB consumption in Argentina. Implementing measures to reduce the sugar content in beverages is a pending debt for the country and could lead to measurable improvements in population health, especially among children and adolescents.
Collapse
Affiliation(s)
- Ariel Esteban Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- * E-mail:
| | - Natalia Espínola
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Darío Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Andrea Olga Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| |
Collapse
|
4
|
Rodríguez Cairoli F, Guevara Vásquez G, Bardach A, Espinola N, Perelli L, Balan D, Palacios A, Augustovski F, Pichón-Riviere A, Alcaraz A. [Burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El SalvadorCarga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador]. Rev Panam Salud Publica 2023; 47:e80. [PMID: 37197598 PMCID: PMC10184580 DOI: 10.26633/rpsp.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/03/2023] [Indexed: 05/19/2023] Open
Abstract
Objective To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. Methods A comparative risk model was used to estimate the effects on deaths, health events, disability-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. Results A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 individuals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. Conclusion A high number of deaths, events, and costs could be attributed to the consumption of sugar-sweetened beverages in El Salvador.
Collapse
Affiliation(s)
- Federico Rodríguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
- Federico Rodríguez Cairoli,
| | - Giovanni Guevara Vásquez
- Universidad Católica de El Salvador (UNICAES)Santa AnaEl SalvadorUniversidad Católica de El Salvador (UNICAES), Santa Ana, El Salvador.
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Natalia Espinola
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Darío Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Andrés Pichón-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| |
Collapse
|
5
|
Ciapponi A, Rodríguez Cairoli F, Solioz G, Rojas-Roque C, Hernández-Vásquez A, Palacios A, Bardach A. Intercambio desde los cigarrillos convencionales a los sistemas electrónicos de administración de nicotina: revisión sistemática rápida con metaanálisis y aspectos económicos. Rev Peru Med Exp Salud Publica 2021; 38:537-550. [DOI: 10.17843/rpmesp.2021.384.7776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/17/2021] [Indexed: 11/06/2022] Open
Abstract
Objetivos. Evaluar cómo y en qué medida se produce un intercambio desde los cigarrillos convencionales (CC) a los sistemas electrónicos de administración de nicotina (SEAN). Materiales y métodos. Se realizó una revisión sistemática hasta agosto de 2019. El desenlace primario fue la proporción de un intercambio completo o parcial de CC a los SEAN y sus aspectos económicos. Los desenlaces secundarios como medidas de resultado fueron la probabilidad de intercambio y la tendencia en el intercambio por países. Resultados. Se encontraron 3628 referencias y se incluyeron 49 estudios con datos epidemiológicos y económicos. Los estudios económicos sobre la elasticidad cruzada de precios mostraron que los CC son parcialmente intercambiables por SEAN. La mayoría de los estudios reportaron que la prevalencia del consumo de cigarrillos electrónicos se incrementó con el tiempo. Tres estudios reportaron una reducción significativa de los CC consumidos por día entre fumadores duales (convencionales más SEAN) en comparación con los consumidores de CC. El odds ratio ajustado y combinado de dejar los CC entre consumidores de SEAN en comparación con quienes nunca consumieron o lo hicieron en el pasado fue de 1,19 (IC95%: 1,09-1,30; heterogeneidad 0%). Los estudios longitudinales mostraron una creciente prevalencia del uso de cigarrillos electrónicos, principalmente en adolescentes. Se encontró una relación negativa entre el consumo y aumento de precio de CC y electrónicos. Conclusión. La probabilidad de dejar de fumar CC entre consumidores habituales de SEAN se incrementó respecto a los consumidores que nunca o que solían consumir SEAN. Estudios económicos reportaron que los cigarrillos electrónicos son parcialmente intercambiables por los CC.
Collapse
|
6
|
Appiani FJ, Rodríguez Cairoli F, Sarotto L, Yaryour C, Basile ME, Duarte JM. Prevalence of stress, burnout syndrome, anxiety and depression among physicians of a teaching hospital during the COVID-19 pandemic. ARCH ARGENT PEDIATR 2021; 119:317-324. [PMID: 34569739 DOI: 10.5546/aap.2021.eng.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/15/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Health care workers experience a tremendous strain while performing their activities, very frequently leading to stress, burnout syndrome, and psychopathological impact. The COVID-19 pandemic may cause physicians to suffer these effects even to a greater extent. Our objective was to describe the frequency of stress, burnout syndrome, anxiety, and depression during the pandemic, and analyze the associations with different independent outcome measures. METHODS Observational, cross-sectional study conducted 2 months after the lockdown was established in Argentina. Clinical specialists, surgeons, emergency physicians, and those with no direct contact with patients were surveyed using a sociodemographic questionnaire and 3 self-administered inventories: Health Professions Stress Inventory, Maslach Burnout Inventory, and Hospital Anxiety and Depression Scale. RESULTS The prevalence of stress was 93.7 % (95 % confidence interval [CI]: 90.33-96.2), burnout syndrome 73.5 % (95 % CI: 68.2-78.4), anxiety 44 % (95 % CI: 38.4-49.8), and depression 21.9 % (95 % CI: 17.3-26.9). No association was observed between the frequency and medical specialty. The frequency of burnout syndrome, anxiety, and depression was significantly higher among residents and physicians working in the emergency department. CONCLUSIONS Residents and emergency physicians working 24-hour shifts showed significantly higher percentages of burnout syndrome, anxiety, and depression compared to staff and head physicians. These findings may be associated with a higher workload and less experience. It is compulsory to take preventive and therapeutic measures to protect those in the pandemic front line.
Collapse
Affiliation(s)
- Francisco J Appiani
- Unidad de Neuropsicofarmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Unidad de Neuropsicofarmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Luis Sarotto
- Departamento de Cirugía. Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudio Yaryour
- División de Emergencias. Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - María E Basile
- Unidad de Neuropsicofarmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Juan M Duarte
- Unidad de Neuropsicofarmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
7
|
Appiani F, Rodríguez Cairoli F, Basile ME, Sarotto L, Duarte JM. The validation of the Bush-Francis Catatonia Rating Scale to Spanish. Argentinian version. Actas Esp Psiquiatr 2020; 48:301-305. [PMID: 33398859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
he present study aims to validate the Spanish version of the Bush Francis Catatonia Rating Scale (BFCRS).
Collapse
Affiliation(s)
- Francisco Appiani
- Jefe de la Unidad de Neuropsicofarmacología. División de Farmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín. Facultad de Medicina. Universidad de Buenos Aires. Profesor Adjunto. Departamento de Psiquiatría y Salud Mental. Facultad de Medicina. Universidad de Buenos Aires
| | - Federico Rodríguez Cairoli
- Felowship. Unidad de Neuropsicofarmacología. División de Farmacología. Dirección de Docencia e Investigación. Hospi- tal de Clínicas José de San Martín. Facultad de Medicina. Universidad de Buenos Aires
| | - María Eugenia Basile
- Asistente de Investigación. Unidad de Neuropsicofarmacología. División de Farmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín. Facultad de Medicina. Universidad de Buenos Aires
| | - Luis Sarotto
- Profesor Titular de Cirugía. Facultad de Medicina. Universidad de Buenos Aires. Jefe de División de Cirugía Gastroen- terológica. Hospital de Clínicas José de San Martín. Facultad de Medicina. Universidad de Buenos Aires. Tutor de Tesis sobre Catatonía y Delirium
| | - Juan Manuel Duarte
- Unidad de Neuropsicofarmacología. División de Farmacología. Dirección de Docencia e Investigación. Hospital de Clínicas José de San Martín. Facultad de Medicina. Universidad de Buenos Aires
| |
Collapse
|
8
|
Duarte JM, Rodríguez Cairoli F, Saguier Padilla I, Ramos SG, Barcia RE, Arévalo CE. [Chronic inflammatory demyelinating polyneuropathy in a diabetic patient with syphilis]. Medicina (B Aires) 2018; 78:286-289. [PMID: 30125257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder characterized by motor symptoms such as weakness in both proximal and distal muscles with globally diminished or absent reflexes. Insulin neuritis is referred as an acute pain in the extremities, due to the damage of peripheral nerves affecting mainly small fibers, in diabetic patients treated with insulin who achieved rapid glycemic control. Pain is unusual in classic CIDP. We report the case of a 54-year-old female patient with type II diabetes mellitus, and a recent onset of insulin therapy, who presented at the emergency room with a 2-month history of weakness and hyperalgesia of extremities. Physical examination showed marked pain and proximal and distal allodynia in the 4 limbs, with reduced muscle strength of the proximal muscles and patellar and achillear areflexia. Electrophysiological study showed sensory and motor polyneuropathy with a demyelinating predominance. Treatment with recombinant human immunoglobin was started, and the patient presented a total remission of the condition. Complementary studies confirmed weak serum positivity of GM1, GD1a, GD1b and anti-asialo GM1. Prior to hospital discharge, results of positive serum VDRL and FTA-Abs were received. VDRL in cerebrospinal fluid was negative, so neurosyphilis was ruled out, and treatment with benzathine penicillin was indicated.
Collapse
Affiliation(s)
- Juan Manuel Duarte
- Sexta Cátedra de Medicina Interna, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina. E-mail:
| | - Federico Rodríguez Cairoli
- Sexta Cátedra de Medicina Interna, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina
| | - Ignacio Saguier Padilla
- Sexta Cátedra de Medicina Interna, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina
| | - Silvia G Ramos
- Laboratorio de Inmunología, Unidad de Inmunología e Histocompatibilidad, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Ricardo E Barcia
- Sexta Cátedra de Medicina Interna, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina
| | - Cecilia E Arévalo
- Sexta Cátedra de Medicina Interna, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina
| |
Collapse
|