Search

Background: The anti-N-methyl-D-aspartate (NMDAr) encephalitis was first described in 2005 and in 2007 the antibodies against the NMDA were identified by Dalmau et al.It is estimated that it affects 1.5 per million individuals every year, but it is more frequent in young women ranging from 15 to 25 years, and 37% of them can manifest as a paraneoplasic syndrome in association with an ovarian teratoma.Case description: A 17-year-old female with personal history of left ovarian teratoma, one week after its surgical removal presents: auditory hallucinations, persecutory delusions, insomnia, anhedonia, agitation, speech impairment, orofacial dyskinesia, and gait alterations during one month. An electroencephalogram (ECG) reported severe cortical-subcortical. The cerebral Magnetic Resonance Imaging (MRI) and the Cerebrospinal Fluid (CSF) analysis, reported no findings. Given the clinical suspicion, immunosuppressive treatment with intravenous corticosteroids was initiated, along with symptomatic management antipsychotic, for agitation and anxiety; initially with midazolam infusion and then with olanzapine, risperidone, and clonazepam; obtaining satisfactory clinical improvement. Finally, the diagnosis was confirmed by a positive IgG against the N1 glutamate subunit (Glu N1) of the NMDAr. Conclusion: The anti NMDAr encephalitis is a rare and underdiagnosed condition, which can be mistaken as a primary psychiatric disease. Given a first psychotic episode, an extense interrogatory and evaluation must be done to exclude secondary causes, such as, autoimmune disorders with neurologic repercusions.

Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Polissacarídeos sulfatados (PSs) da alga vermelha comestível Gracilaria birdiae possuem atividade antioxidante. Trabalhos anteriores mostram que PSs, quando em forma de nanopartículas de prata (NpsAg), apresentam melhor atividade antioxidante do que em sua forma original. Contudo, não há dados referentes a NpsAg sintetizadas com PSs de G. birdiae. Portanto, NpsAg sintetizadas a partir dos PSs de G. birdiae foram obtidas e avaliadas como agentes antioxidantes. Foram realizadas a detecção e a medição de tamanho das NpsAg por dispersão de luz dinâmica (DLS). O extrato de PS foi avaliado quanto a sua capacidade redutora pelo teste de capacidade antioxidante total (CAT). A capacidade antioxidante das NpsAg e dos PS também foi determinada pelo teste de quelação férrica. O teor de proteínas e de açúcar foi determinado por espectrofotometria. Os PS apresentaram CAT, e isso habilitou-os para a síntese de NpsAg. As NpsAg apresentaram tamanho médio de 117,6 nm. Nenhuma contaminação proteica foi encontrada nos PSs e nas NpsAg. O teor de açúcar na suspensão de NpsAg (55,7%) foi superior ao encontrado na solução de PSs (49,7%). A suspensão com NpsAg apresentou uma atividade quelante de ferro 25% maior que a solução de PSs. Os resultados mostraram que os PSs de G. birdiae, sob a forma de nanopartículas, tiveram a sua atividade quelante de ferro potencializada, indicando que as nanopartículas de prata podem ser objeto de futuros estudos para identificar seu potencial como agentes antioxidantes em diferentes aplicações.

Introduction In the Chilean health system, difficulties complicate women’s access to health care and aggravate the complexity of health-illness processes in their interaction as users or caregivers. Objective In the national and international literature, we aimed to identify gaps in women’s access to health care derived from gender disparities and the exercise of gender roles in a prioritized set of health problems. These problems exacerbate gender gaps and should be considered in health reform. Methods We made a literature review through algorithms, snowball sampling, and reference lists from November 2020 to March 2021. The population included were women of all ages, including women users of the health system and women caregivers of specific pathologies. The search was conducted in parallel by four investigators divided into two groups. It was cross-validated to ensure inter-investigator reliability by standardizing evidence eligibility criteria. The analysis showed women users' and caregivers' dimensions for a set of pathologies prioritized by the extent of the disease burden. The pathologies analyzed included stroke, obesity, depression, musculoskeletal pain, and breast cancer. Results Among women users of the health system, problems of access, rates of use, experience, and outcome for the whole group of prioritized pathologies were observed. In the women caregiver dimension, we found that women are the primary health care providers. There is a knowledge gap concerning obesity and musculoskeletal conditions. However, both were reported as health consequences of women’s caregiving roles.

Introduction Several studies demonstrate the therapeutic superiority of thrombolysis plus mechanical thrombectomy versus thrombolysis alone to treat stroke. Objective To analyze the cost-utility of thrombolysis plus mechanical thrombectomy versus thrombolysis in patients with ischemic stroke due to large vessel occlusion. Methods Cost-utility analysis. The model used is blended: Decision Tree (first 90 days) and Markov in the long term, of seven health states based on a disease-specific scale, from the Chilean public insurance and societal perspective. Quality-Adjusted Life-Years and costs are evaluated. Deterministic (DSA) and probabilistic (PSA) analyses were carried out. Results From the public insurance perspective, in the base case, mechanical thrombectomy is associated with lower costs in a lifetime horizon, and with higher benefits (2.63 incremental QALYs, and 1.19 discounted incremental life years), at a Net Monetary Benefit (NMB) of CLP 37,289,874, and an Incremental Cost-Utility Ratio (ICUR) of CLP 3,807,413/QALY. For the scenario that incorporates access to rehabilitation, 2.54 incremental QALYs and 1.13 discounted life years were estimated, resulting in an NMB of CLP 35,670,319 and ICUR of CLP 3,960,624/QALY. In the scenario that incorporates access to long-term care from a societal perspective, the ICUR falls to CLP 951,911/QALY, and the NMB raises to CLP 43,318,072, improving the previous scenarios. In the DSA, health states, starting age, and relative risk of dying were the variables with the greatest influence. The PSA for the base case corroborated the estimates. Conclusions Thrombolysis plus mechanical thrombectomy adds quality of life at costs acceptable for decision-makers versus thrombolysis alone. The results are consistent with international studies.

Introduction In Chile, there is controversy regarding the magnitude of financing for the health system. Some experts state that more resources are needed, while others refer to the problems that may arise in managing a growing pool of resources. Aim This article aims to offer evidence to encourage critical discussion through a time series analysis of the leading financial aggregates in constant 2018 Chilean pesos of the Chilean social security in the period from 2000 to 2018. Methods We did an observational, descriptive, longitudinal, and time series trend analysis study. Financial aggregates are organized according to social security definitions and by financial administrators—the public National Health Fund and the private health insurers. Results Social security health spending has increased almost four-fold in the study period. After enacting the Explicit Guarantees in Health, the National Health Fund expanded more than the private health insurance system due to government allocations to the National Health Fund. In contrast, individual contributions decreased steadily every year during the study period. Per capita expenditure was higher in the private health insurance system. However, the per capita expenditure of the private insurance system over the public health fund has gradually decreased over time. Conclusion Firstly, Chile increased its health spending at a rate higher than observed in other Organization for Economic Co-operation and Development countries. Secondly, it transitioned from financing health mainly through workers’ contributions to growing prominence of the government’s overall contribution. In the wake of the announced health reform, the discussion of health funding will include employers’ role in health financing.

Background Osteoarthritis is an important health condition due to its prevalence and functional deterioration, being the most common cause of disability in people over 65 years of age. The Chilean Explicit Health-Guarantees regime provides coverage for medical treatment in mild and moderate presentations, excluding surgical treatment in end-stage knee osteoarthritis. Objectives To evaluate the cost-utility of incorporating total knee replacement to the Explicit Health-Guarantees regime for over-65-years beneficiaries of the public insurance system, versus maintenance with medical treatment. Methods A Scoping review was coducted to identify model parameters and economic evaluation based in a 6 health states Markov Model, from the perspective of the public payer and lifetime horizon. The Incremental Cost-Utility Ratio (ICUR) was calculated, and deterministic and probabilistic uncertainty analysis were performed. Results Twenty-two articles were selected as reference sources. If the regime were to adopt the procedure, the implication would be a benefit of 9.8 Years of Life Adjusted by Quality (QALY) versus 2.4 QALY in the scenario without access to total knee replacement. The ICUR was $ -445 689 CLP/QALY (U$D -633.8/QALY), wherein the inclusion of total knee replacement to the regime becomes a dominant alternative versus the current scenario. Each quality-adjusted life-year gained by the surgery will save CLP 445 689. At a willingness to pay of CLP 502,596/QALY (U$D 714.7/QALY), access to surgery is cost-useful with a 99.9% certainty. Conclusion Total knee replacement in patients older than 65 years is a dominant alternative. Access to this procedure in the Chilean Explicit Health-Guarantees regime in the public system is cost-useful at a threshold of 1 GDP per capita.

Introduction Healthcare systems are developed in imperfect scenarios, in which there are constant failures (uncertainty, information asymmetry, agency relationship problem, and supply-induced demand). These failures, based on the imperfection of the sector, determine the relationships and incentives between the actors. It is within this context that payment mechanisms regulate aspects of the system behavior and incentives, acting as instruments for the purchasing of health care from providers, mediated by health insurance on behalf of users. Objective To characterize the basic elements of most frequent payment mechanisms to help providers in their relationship with payers. Methods A review of the evidence was conducted in PubMed, Google, Google Scholar, and strategic snowball selection. Payment mechanisms consist of three classical microeconomics variables, fixed or variable: price, quantity, and expense. Time dimensions are used to analyze their attributes and effects. Different mechanisms emerge from the combination of these variables. Results Among the most used are: Fee-For-Service, Global Budget, Bundled Payments, Diagnosis-Related Groups, Per-capita, Performance Pay, and Risk-Sharing Agreements. A fourth has also gained importance: Financial Risk. Conclusions Payment mechanisms are essential to link health efforts with clinical practice. They make it possible to regulate relationships between insurers, providers, and users, which, depending on the architecture of the mechanism, can become beneficial or hinder the fulfillment of the objectives of the health system.