Measuring the economic burden of neuromyelitis optica spectrum disorder in Colombia

OBJECTIVE

To assess the economic burden of neuromyelitis optica spectrum disorder (NMOSD) in the Colombian context.

METHODS

Analyses were conducted from a societal perspective using the prevalence-based approach. Costs were expressed in 2022 US dollars (1 USD = $3,914.46 COP). Direct medical costs were assessed from a bottom-up approach. Indirect costs included loss of productivity of the patient and their caregivers. The economic burden of NMOSD in Colombia was estimated as the sum of direct and indirect costs.

RESULTS

The direct cost of treating a patient with NMOSD was USD$ 8,149.74 per year. When projecting costs nationwide, NMOSD would cost USD$ 7.2 million per year. Of these costs, 53.5% would be attributed to relapses and 34.4% to pharmacological therapy. Indirect costs potentially attributed to NMOSD in Colombia were estimated at USD$ 1.5 million per year per cohort. Of these, 78% are attributable to loss of patient productivity, mainly due to reduced access to the labor market and premature mortality.

CONCLUSIONS

The NMOSD has a representative economic burden at the patient level, with direct costs, particularly related to relapses and medicines, being the main component of total costs. These findings are useful evidence that requires attention from public policymakers in Colombia.

Effects of aging and dietary supplementation with polyphenols from Pinus taeda hydrolysed lignin on quality parameters, fatty acid profile and oxidative stability of beef

Context The inclusion of Pinus taeda hydrolysed lignin (PTHL) in beef diets could improve quality and stability of meat, but effects could vary through the aging period (AP). Aim The aim was to evaluate the effects of the PTHL inclusion in the diet of finishing beef cattle on meat quality, fatty acid composition and oxidative stability at Days 1, 8, 11 and 15 of aging. Methods Forty Limousin bulls (340 ± 42 kg) were fed ad libitum on a total mixed ration (TMR). The control group received exclusively TMR for 120 days, while the experimental group received the same TMR as the control group but supplemented with PTHL (Oxifenol, I-Green, Padua, Italy; 35 g/day per head at 1–90 days and 70 g/day per head at 91–120 days). Key results Diet did not influence the chemical composition, pH, cooking loss, Warner–Bratzler shear force and hydroperoxide content. The Warner–Bratzler shear force (P < 0.001) decreased, while lightness (P < 0.01) and hydroperoxides (P < 0.001) increased through the aging period. Thiobarbituric acid reactive substances were similar for both diets at 1 and 15 days. However, thiobarbituric acid reactive substances at 8 and 11 days were higher for control than for the PTHL diet (P = 0.023 for interaction). Protein carbonyls were higher for control than for the PTHL diet at 8 days (P = 0.003 for interaction), but similar for both diets for the other dates. Saturated, monounsaturated and polyunsaturated fatty acids varied through the AP with PTHL diet, while no changes were observed with control diet (P < 0.01 for interactions). At 11 days, the n-6:n-3 ratio passed from being the minimum value with the PTHL diet to be the maximum with control diet (P < 0.01 for interaction). Conclusions The effects of PTHL inclusion in bull finishing diets depends on the AP but, generally, may result in beef with meat with beneficial effects on human health. Implications Including PTHL in the diet of finishing bulls can be useful to improve meat quality, favouring the use of natural waste substances deriving from vegetal production.

SURVEILLANCE OF ENVIRONMENTAL DOSE RATE WITH THE COVARIANCE MATRIX

The objective of this study is the operational verification of an environmental dose rate monitoring network composed by several sensors. The verification of the study has been tested on the CIEMAT's Radiological Network, establishing a records quality assurance of the detectors using the covariance matrix and the eigenvalues. The technique has revealed an underlying records malfunction, which have not been appreciated by applying conventional surveillance. In this sense, the malfunction has economic and security consequences, which can be minimized with an alternative methodology, which guarantees the radiological protection of a local area according to the Regulatory Agency.

USING THE HERMITE POLYNOMIALS IN RADIOLOGICAL MONITORING NETWORKS

The most interesting events in Radiological Monitoring Network correspond to higher values of H*(10). The higher doses cause skewness in the probability density function (PDF) of the records, which there are not Gaussian anymore. Within this work the probability of having a dose >2 standard deviations is proposed as surveillance of higher doses. Such probability is estimated by using the Hermite polynomials for reconstructing the PDF. The result is that the probability is ~6 ± 1%, much >2.5% corresponding to Gaussian PDFs, which may be of interest in the design of alarm level for higher doses.

Case Report: Rapid Eye Movement Sleep Behavior Disorder as the First Manifestation of Multiple Sclerosis: A Case Report and Literature Review

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by brief recurrent episodes of loss of muscle atonia during rapid eye movement sleep, with enacted dreams that cause sleep disruption. Patients with multiple sclerosis (MS) have an increased risk compared with the general population to be affected by a sleep disturbance, including RBD. Patients affected, however, uncommonly can present RBD as the first clinical manifestation of MS without other neurologic deficits. These clinical presentations have usually been attributed to inflammatory lesions in the pedunculopontine nuclei, located in the dorsal pons. We present a case of RBD in a 38-year-old woman who was later diagnosed as having MS due to imaging findings and development of focal neurologic deficits. MS should be considered among the differential diagnoses in patients who present with symptoms of RBD, particularly if they are young and female.

ADVANCED SURVEILLANCE OF ENVIROMENTAL RADIATION IN AUTOMATIC NETWORKS

The objective of this study is the verification of the operation of a radiation monitoring network conformed by several sensors. The malfunction of a surveillance network has security and economic consequences, which derive from its maintenance and could be avoided with an early detection. The proposed method is based on a kind of multivariate distance, and the verification for the methodology has been tested at CIEMAT's local radiological early warning network.

Cerebral toxoplasmosis in an MS patient receiving Fingolimod

Multiple Sclerosis (MS) is an autoimmune disease in which lymphocytes target putative myelin antigens in the CNS, causing inflammation and neurodegeneration. Fingolimod (FTY720) is an immunosuppressive drug used as a second line therapy for relapsing forms of MS due to its safety profile and good response to treatment. Despite its safety, there are still concerns about the possibility of Fingolimod being linked to the development of opportunistic infections like disseminated varicella zoster infections and herpes simplex encephalitis. In this case report, we describe one patient with past medical history of MS in current treatment with Fingolimod for the last year which presents herself with hemiparesis, fever and fatigue. The initial MRI showed multiple demyelinating-like lesions that could have corresponded to the tumefactive form of MS relapse. The blood work up revealed leukopenia with lymphopenia and a CD4+ count of 200 cell/mm³. Treatment for acute relapse was initiated with little to no response. Further examination was carried by the clinicians, a lumbar puncture was performed and it showed pleocytosis with increased protein levels. Later, several serologic studies were performed and both IgM and IgG antibodies for Toxoplasma were positive. Diagnosis of cerebral toxoplasmosis was made and there was no evidence of HIV infection or other causes of secondary immunodeficiency in this patient, except the use of fingolimod. Evidence of decreased levels of CD4+ due to Fingolimod use is concerning. The risk of opportunistic infections in these patients must be considered in order to start or continue therapy with these agents. Further studies are needed to determine the percentage of the population at risk of immunosuppression and its long-term consequences as well as new actions to prevent infections.

The Influence of Radon (Gas and Progeny) and Weather Conditions on Ambient Dose Equivalent Rate

The purpose of this study is to identify the influence of radon (gas and progeny) on the ambient dose equivalent rate measured at the reference station ESMERALDA, where continuous measurements of the ambient dose equivalent rate (every 10 min) combined with activity concentration measurements of radon gas and radon progeny as well as meteorological parameters have been collected. This study has been performed using a correlation study based on a principal components analysis and the Spearman's rank correlation coefficient.

Effects of ionizing radiation and temperature on uranyl silicates: soddyite (UO2)2(SiO4)(H2O)2 and Uranophane Ca(UO2)2(SiO3OH)2·5H2O

The stability of soddyite under electron irradiation has been studied over the temperature range of 25-300 °C. At room temperature, soddyite undergoes a crystalline-to-amorphous transformation (amorphization) at a total dose of 6.38 × 10(8) Gy. The electron beam irradiation results suggest that the soddyite structure is susceptible to radiation-induced nanocrystallization of UO(2). The temperature dependence of amorphization dose increases linearly up to 300 °C. A thermogravimetric and calorimetric analysis (TGA-DSC) combined with X-ray diffraction (XRD) indicates that soddyite retains its water groups up to 400 °C, followed by the collapse of the structure. Based on thermal analysis of uranophane, the removal of some water groups at relatively low temperatures provokes the collapse of the uranophane structure. This structural change appears to be the reason for the increase of amorphization dose at 140 °C. According to the results obtained, radiation field of a nuclear waste repository, rather than temperature effects, may cause changes in the crystallinity of soddyite and affect its stability during long-term storage.

Three trocars laparoscopic resection of angiomyolipoma of the liver

Angiomyolipoma of the liver (AML) is an infrequent neoplasm composed of three tissues (adipose, muscle and vessels). In spite of advances in radiology, preoperative correct diagnosis is difficult. Clasically, a conservative management strategy was adopted in patients with asymptomatic tumors less than 5 cm with undoubtful diagnosis. But after publishing some few cases of malignant angiomyolipoma a more radical has been advocated. Laparoscopic resection of liver tumors is becoming a excellent approach for operating on benign liver tumors. Usually is performed using five trocars but in some cases a less invasive technique with three trocars could be used. We present a laparoscopic resection of liver angiomyolipoma in a 65 year-old male using only three trocars and also discuss the optimal management of AML and technical tips of three-trocar technique.

Effect of cryopreservation on the structural and functional integrity of cell membranes of sugarcane (Saccharum sp.) embryogenic calluses

In this paper, we investigated if the differences consistently noted in survival and plantlet production between cryopreserved and non-cryopreserved, control sugarcane embryogenic calluses were related to modifications induced during cryopreservation in the structural and functional integrity of cell membranes. For this, the evolution of electrolyte leakage, lipid peroxidation products and cell membrane protein contents was measured during 5 d after cryopreservation. Differences between control and frozen calluses were observed only during the first 2 (electrolyte leakage) or 3 d (lipid peroxidation products and membrane protein content) after freezing. It was not possible to link these differences with the differences noted in survival and plant production between control and cryopreserved calluses. Additional studies are thus needed to elucidate which biochemical factors, linked to survival and plantlet regeneration, are affected by cryopreservation.

[Dichotomous keys for identifying Staphylococcus isolated from bovine milk]

Many efforts have been done in order to identify species of Gram positive and catalase positive coccus isolated from raw milk. The aim of this epidemiological observation, was to identify different strains isolated from raw milk according to conventional criteria and to recommend a useful and practical methodology for their correct identification. Gram positive and catalase positive coccus were tested for bacitracin resistance, novobiocin susceptibility, coagulase and others tests (e.g. carbohydrate fermentation). Dichotomic keys were designed to typify Staphylococcus' species. They were grouped into: Group I, coagulase positive, novobiocin susceptibility; Group II coagulase negative novobyocin resistance; and Group III coagulase negative novobiocin susceptibility. 62 strains were tested and S. hycus (17.7%) was the most isolated species, S. aureus (14.5%), S. sciuri (12.9%) and S. haemolyticus (11.3%) were also isolated. S. epidermidis was not isolated.

Interaction of low density lipoproteins with arterial proteoglycans. The role of charge and sialic acid content

The interaction of low density lipoproteins (LDL) with chondroitin sulfate-rich arterial proteoglycans appears to be initiated by coulombic interactions that lead to insoluble complexes. Once formed, large LDL aggregates are held together by non-polar associations. The irreversible formation of LDL proteoglycans aggregates was evaluated for different LDL preparations by definition of an avidity coefficient (Ar) using a Langmuir isotherm. LDL from different subjects, when tested against the same lipoprotein-complexing proteoglycan (LCP), gave Ar values ranging from 1-9 X 10(6) L/M. High avidity values were associated to lipoproteins with apparent isoelectric points above 6.5. These lipoproteins show low sialic acids content. The content of N-acetyl and N-acetyl,O-acetyl sialic acid was found inversely correlated with the avidity coefficient for the arterial LCP. Reductions of 42% on the LDL sialic acid content, by neuraminidase treatment, induced a 10-fold increment in their avidity for the lipoprotein complexing proteoglycan. The results indicate that at low ionic strength and physiological Ca2+-concentration and pH, the surface charge of LDL is an important modulator of the interaction with the arterial proteoglycan. Sialic acid, perhaps because of its exposure at the LDL surface, plays a determinant role in the in vitro association of LDL with the polyanionic proteoglycans. It is possible that in the intima-media the sialic residues of LDL and its balance of surface charges will control part of the interactions with the proteoglycans of the extracellular matrix.