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Alvis N.,University of Cartagena | Suarez J.C.,Instituto Neurologico Of Colombia | Duque A.,Neurologo Fundacion Santafe de Bogota
Value in Health

Objective: To estimate, according to the states of disease (remission or relapse) and her level of progression (EDSS), the cost of treatment of Multiple Sclerosis (MS) in Colombia. Methods: From the perspective of the third payer, a cost study of MS was performed using two-way estimation techniques: a) "Top down" to estimate the costs during relapses from clinical registers of 304 patients; b) "bottom-up" to estimate the cost in remission from a questionnaire (Kobelt 2006) applied to 137 patients, located in different regions of Colombia. Results: The mean of patient's age was 43,7 years and 73% of those were women. The mean annual cost per patient varied according to the disease phase, finding the highest value in Phase II (EDSS 3 5,5) with $ 50.581.216 COP (US$ 25.713) and the lowest one in Phase IV (EDSS 8 - 9,5) with $20.738.845 COP (US$ 10.543). The cost of Disease Modifier Drugs (DMD) represented 91.5% from the medial total annual cost of 1,2 and 3 phases. The participation of DMD was 58%.in the 4 phase. Indirect costs are minimal participation in all phases, except for 4 where increases at the expense of reduced consumption of DMD. Costs associated with the period of relapses of MS are low against the total cost, with an average cost of $ 2,433,182 COP ($ 1.237USD). Discussion: MS in Colombia is a disease with a behavioral pathology "high cost " to the social security system (SGSSS), generated mainly at the expense of their direct costs, which, even without including relapses, an aggregate amount of more than 75 times the annual premium cost of health insurance for Colombia ($ 430,488 COP) in the year under review (2008) © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Source

Hormaza Angel M.P.,Pontifical Bolivarian University | Lopera Valle J.S.,Pontifical Bolivarian University | Massaro Ceballos M.M.,Pontifical Bolivarian University | Massaro Ceballos M.M.,Instituto Neurologico Of Colombia | And 2 more authors.
Clinica e Investigacion en Ginecologia y Obstetricia

Objective: To compare the prevalence of metabolic syndrome in postmenopausal women by applying the IDF and the NCEP/ATPIII criteria and to assess the risk of cardiovascular disease in postmenopausal women and associated risk factors. Material and methods: A cross-sectional study of 224 women aged ≥45 years was carried out following IDF and NCEP/ATPIII guidelines. Cardiovascular risk was estimated using Framingham projections of 10-year absolute cardiovascular disease risk and AHA cardiovascular disease risk assessment. Results: Among evaluated women, the mean age was 59 years (SD 8.36 years). Half of the women had had their last menstrual period >10 years previously, from the FUM (RIQ: 5-18). A total of 62.9% were overweight or obese. The prevalence of metabolic syndrome was 57.1% according to the IDF criteria (IC 95%: 50.4-63.7) vs. 37.5% according to the NCEP/ATPIII criteria (IC 95%: 31.1-44.2). Framingham score was >10% in 46% of the women. According to AHA criteria, 76.8% were at risk, or at high risk, for cardiovascular disease. In the multivariate analysis, the factors most strongly associated with metabolic syndrome according to IDF criteria were obesity (OR 5.05; IC 95%: 2.18-11.69) and age >65 years (OR 2.75; IC 95% 1.34-5.64). The factors most strongly associated with cardiovascular risk were hypertension (OR 11.58; IC 95%: 4.81-27.86), low levels of high-density lipoprotein cholesterol (OR 16.63; IC 95%: 5.96-46.37), and age >55 years (OR 4.5; IC 95%: 1.90-10.67). Conclusion: The joint application of the IDF criteria for metabolic syndrome and the AHA criteria for cardiovascular disease risk assessment is useful to identify a greater number of women at risk. © 2012 Elsevier España, S.L.U. Source

Giraldo M.,University of Antioquia | Giraldo M.,Instituto Neurologico Of Colombia | Lopera F.,University of Antioquia | Siniard A.L.,The Translational Genomics Research Institute TGEN | And 15 more authors.
Neurobiology of Aging

Recent evidence suggests that rare genetic variants within the TREM2 gene are associated with increased risk of Alzheimer's disease. TREM2 mutations are the genetic basis for a condition characterized by polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) and an early-onset dementia syndrome. TREM2 is important in the phagocytosis of apoptotic neuronal cells by microglia in the brain. Loss of function might lead to an impaired clearance and to accumulation of necrotic debris and subsequent neurodegeneration. In this study, we investigated a consanguineous family segregating autosomal recessive behavioral variant FTLD from Antioquia, Colombia. Exome sequencing identified a nonsense mutation in TREM2 (p.Trp198X) segregating with disease. Next, using a cohort of clinically characterized and neuropathologically verified sporadic AD cases and controls, we report replication of the AD risk association at rs75932628 within TREM2 and demonstrate that TREM2 is significantly overexpressed in the brain tissue from AD cases. These data suggest that a mutational burden in TREM2 may serve as a risk factor for neurodegenerative disease in general, and that potentially this class of TREM2 variant carriers with dementia should be considered as having a molecularly distinct form of neurodegenerative disease. © 2013 Elsevier Inc. Source

Introduction: Cerebral venous sinus thrombosis represents 0.5 - 1% of all cerebrovascular diseases. Objective: The aim of this study was to determine the epidemiological, clinical, and imaging features of the disease, as well as the outcomes of patients with cerebral venous sinus thrombosis, and to explore the characteristics associated with unfavorable patient outcomes. Materials and methods: In this cross-sectional, retrospective study, the medical records of 37 patients with cerebral venous sinus thrombosis were analyzed. Results: Eighty-six percent of the patients were women, and the mean patient age was 41 years. The most frequently reported symptom was headache (86.5%); headache was the single presenting symptom in 40.5% of the patients. Sixty-eight percent of the patients had at least one risk factor, the most frequent of which was obesity (24.3%). A total of 43.2% of the patients had no focal neurological findings. The most common finding on computerized tomography (CT) was hyperdense venous sinuses; on Magnetic Resonance Imaging (MRI), the most common finding was venous infarction. On average, 2.27±1.3 sinuses were involved; most frequently, the transverse venous sinuses were affected. The average hospital stay was 7.8±3.6 days. At hospital discharge, the outcomes were favorable in 92% of the patients, and the mortality rate was 5.4%. Conclusions: Cerebral venous sinus thrombosis is a different type of cerebrovascular disorder, with distinct epidemiology, risk factors, clinical presentations and functional outcomes. The diagnosis is based on clinical suspicion because of the unspecific clinical presentation of the disease. Source

Velasquez J.J.,University of Antioquia | Suarez X.,University of Antioquia | Aristizabal I.,University of Antioquia | Ascencio J.,Instituto Neurologico Of Colombia | Ochoa J.,University of Antioquia
Pan American Health Care Exchanges, PAHCE

Brain connectivity refers to the time dependence of neural activity between anatomically separated regions. Using the techniques of functional MRI (fMRI) and elements of the graph theory is possible to identify functional connectivity networks. Because functional connectivity between brain regions can characterize the integrity of large-scale systems, there is great interest in understanding the variability of these networks in normal development and clinical settings, for the presence of neurological diseases such as multiple sclerosis (MS) that affects the neuronal communication speed leading to a reduction or loss of function. This paper shows the implementation of a methodology for the analysis of the BOLD signal at rest using graph theory in high resolution (20092 voxels). There is obtained functional connectivity networks for healthy subjects and patients with MS, and calculated measurements of average degree, efficiency, transitivity, degree distribution and entropy for each network. It was found that in MS patients exists variations in all measures, suggesting greater connectivity associated a possible mechanism of brain plasticity in response to damage caused by the disease. © 2013 IEEE. Source

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