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Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

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World Journal of Transplantation 2024年第2期14卷 76-87页

作者： Andrés gómez-De León Yesica A López-Mora Valeria garcía-Zárate Ana Varela-Constantino Sergio U Villegas-De Leon Xitlaly J gonzález-Leal Raúl del Toro-Mijares Anna C rodríguez-Zúñiga Juan F Barrios-Ruiz Victor Mingura-Ledezma Perla R Colunga-Pedraza olga g cantú-rodríguez César H gutiérrez-Aguirre Luz Tarín-Arzaga Elías E gonzález-López David gómez-Almaguer Hematology Service Universidad Autónoma de Nuevo LeónFacultad de Medicina y Hospital Universitario Dr.JoséEleuterio GonzálezMonterrey 64460Nuevo LeónMexico Hemato-logy Service Clínica Gómez AlmaguerMonterrey 64710Nuevo LeónMexico Hematology Service Instituto Tecnológico de Estudios Superiores de MonterreyTec SaludEscuela de Medicina Ignacio SantosMonterrey 64710Nuevo LeónMexico

BACKgROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly *** observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private *** To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in *** In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from *** were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in *** payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and *** outcomes included overall survival(OS),categorized by residence,referral,and payment *** outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression *** software included SPSS and R with tidycmprsk *** Our primary outcome was overall *** included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients dia

关键词： Hematopoietic cell transplant Social determinants of health geography Haploidentical Out-of-pocket Financial toxicity Survival Health services and outcomes Hematopoietic malignancy Aplastic anemia

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Mexican guidelines for the Diagnosis and Treatment of Chronic Myeloid Leukaemia

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Journal of Cancer Therapy 2013年第3期4卷 747-764页

作者： Eduardo Cervera Federico godínez Rosa Sosa Ramón Rivas Carlos Best Juan Hernández Adrián Morales Hugo Zurita Ivette Carrasco Jorge Cruz álvaro Aguayo José Espinoza Juan Labardini Luis Valero Judith Cruz Diana Arcos Diego Limón Omar López-Navarro Daniela gordillo-Bastidas Myrna Candelaria Francisco Torres Juan Kassack Oscar de Jesús Pérez Ramírez Jorge Aquino guillermo Díaz Mariela Cardiel Margarita rodríguez Patricia Montoya Juan Contreras María Chávez Sandra Chávez David gómez olga cantú Jorge Duque Luis Pita Eduardo Lobato Julio López Antonio López Pedro gonzález Jorge Cortés Haematology and Oncology Department National Institute of Medical and Nutrition Sciences “Dr. Salvador Zubirán” Mexico City Mexico Haematology Deparment from Hospital Juárez Mexico City Mexico Haematology Department Blood Bank and Unit of Aphaeresis General Hospital of Culiacán Health Ministry Culiacán Mexico Haematology Department Bone Marrow Transplant and Blood Bank from Hospital Regional de Alta Especialidad “Dr. Juan Graham Casassus” Villahermosa Mexico Haematology Department Cancerology National Institute (INCan) Mexico City Mexico Haematology Department Cancerology National Institute (INCan) Mexico City Mexico 2Internal Medicine Haematology Hospital ISSSTECALI Tijuana Mexico Haematology Department Centenario Hospital Miguel Hidalgo Health Ministry Aguascalientes Mexico Haematology Department General Hospital of Sonora State Sonora Mexico Haematology Department Hospital Universitario UANL Monterrey Mexico Haematology Haematology Service Hospital General Regional SSG León Mexico Haematology Head of Haematology Service School of Medicine Autonomous University of San Luis Potosí San Luis Potosí Mexico Haematology Hospital “Aranda de la Parra” León Mexico Haematology Hospital General de Especialidades Campeche Mexico Haematology Hospital General de México Mexico City Mexico Haematology Hospital General de Occidente SSA Guadalajara Mexico Haematology Hospital Regional de Alta Especialidad de Oaxaca Oaxaca Mexico Haematology Mérida Clinic Yucatán Mexico Haematology Oncology Unit SSEP Puebla Mexico Hospital Betania Puebla Mexico Hospital of the Poblano Child Puebla Mexico Internal Medicine Haematology Hospital ISSSTECALI Tijuana Mexico Leukaemias Clinic at ISSEMyM Toluca Mexico Leukemia Department MD Anderson Cancer Center Houston Mexico Los Mochis general Hospital Sinaloa Mexico Renaissance Clinic Morelia Mexico State Council for AIDS Prevention and Control Chihuahua Mexico Universidad Autónoma de Yucatán Mérida Mexico

Background: This document includes recommendations and guidelines issued by a group of Mexican researchers and specialists gathered in the First National Colloquium for the Diagnosis and Management of Chronic Myeloid Leukaemia (CML) by initiative of Instituto Nacional de Cancerología and with the support of the Leukaemia Department of the MD Anderson Cancer Center. Mexico lacks of updated information taken from its own reality on the diagnosis and treatment of CML and other haematological disorders;besides, there are no national guidelines. Aim: To publish a consensus document with guidelines for the management of CML adjusted to the national environment and overall characteristics. Method: The participants answered a DELPHI questionnaire about the overall aspects of the disease, aiming to target controversial topics, discuss them in the colloquium, and to agree on the best ones. After those meetings, a final document was drawn up. Results: The group presents recommendations for definition, diagnosis, prognosis, monitoring, and treatment of CML in Mexico. Conclusions: Having consensus guidelines for the clinical management of CML in our country will enable the consensual practice of Mexican specialists regarding the clinical approach to CML, as well as optimize the resources which allow the rational planning of the medical care strategies.

关键词： Chronic Myeloid Leukaemia Management guidelines Diagnosis Treatment.

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Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter

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World Journal of Emergency Medicine 2015年第1期6卷 10-15页

作者： Yuanting Zha Michelle Zhou Anjali Hari Bradley Jacobsen Neha Mitragotri Bianca Rivas olga gabriela Ventura Janice Boughton John Christian Fox Irvine School of Medicine University of California gritman Medical Center Department of Emergency Medicine Irvine Medical Center University of California

BACKgROUND: Over 90% of all cases of malaria worldwide occur in Africa. Current methods of diagnosis are time and labor intensive, and could lead to delayed ***: In this study we investigated the effectiveness of measurements of spleen, liver, and optic nerve sheath diameter(ONSD) in identifying patients with malaria or severe malaria through the use of hand-held ultrasound devices. We recruited 40 adult patients with malaria and 16 adult control subjects at two hospitals in Mwanza, Tanzania. Ultrasonographic diagnosis was compared with rapid antigen diagnostic test and peripheral blood smear as the gold standards. An receiver operating characteristic curve test was performed to determine the most optimal diagnostic threshold for malaria and severe malaria, using each of the measurements for liver size, spleen size, and ONSD. The thresholds were determined to be >12 cm for spleen length and >15.1 cm for liver length, whereas ONSD was not signifi cant in this ***: The sensitivities for malaria diagnosis were 66.7% and 58.3% for liver and spleen length respectively, suggesting that these measurements may not be suitable for identifying patients with severe malaria. However, the high specificity of 90.9% for spleen length and the acceptable specifi city of 75.0% for liver length suggest that these measurements can be used as a method to eliminate false-positive diagnoses(i.e. patients who do not have severe malaria but are classifi ed as having it by a test with a high sensitivity), giving a high positive predictive ***: We report a high specifi city for spleen size and a moderate specifi city for liver size in the ultrasonographic diagnosis of severe malaria. Thus when paired with a highly sensitive method of malaria diagnosis, ultrasonographic measurement of spleen and liver size is promising as part of a diagnostic algorithm for malaria. It could be used to stratify risk in patients diagnosed with malaria and assist in their tri

关键词： Diagnostic ultrasound Malaria International health Sub-Saharan Africa Tanzania

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