Economic,Patient Preference,and Health-Related Quality of Life Considerations for Intranasal Corticosteroids in Allergic Rhinitis

Allergic rhinitis, as a medical condition, merits attention because of its prevalence in the population as well as the substantial economic impact of treating it. By virtue of their efficacy and low adverse effect profile, intranasal corticosteroids have gained recognition by healthcare providers as the first-line therapy for allergic rhinitis. For managed care decision makers, the use of intranasal corticosteroids as the gold standard of treatment in allergic rhinitis makes comparative economic and humanistic (patient preference or health-related quality of life [HR-QOL]) data between the various intranasal corticosteroids increasingly important for formulary decisions.Although the equal efficacy and safety of intranasal corticosteroid products in the treatment of allergic rhinitis is well documented, research that compares the different economic and humanistic aspects of intranasal corticosteroid products is limited and less conclusive. In this article, we review published studies reporting pharmacoeconomic and humanistic analyses of intranasal corticosteroids in the treatment of allergic rhinitis and make recommendations for managed care decision makers in the selection of intranasal corticosteroids for allergic rhinitis. Based on inclusion/exclusion criteria, 15 pharmacoeconomic and 19 patient preference/HR-QOL studies were selected and reviewed.The literature reviewed does not provide evidence of the superiority of a single intranasal corticosteroid product with respect to pharmacoeconomic, patient preference, or HR-QOL considerations. This finding is primarily owing to the lack of published head-to-head studies comparing pharmacoeconomic or humanistic outcomes between the different intranasal corticosteroids. Without further head-to-head studies on intranasal corticosteroids for the treatment of allergic rhinitis, cost minimization results may be the best decision strategy for managed care organizations (MCOs). Ideally, the results of cost-effectiveness or cost-utility studies comparing the different intranasal corticosteroids should guide the final formulary decision. In the absence of such studies, pharmacoeconomic and humanistic outcomes data from studies reported in the literature should be included into a pharmacoeconomic model, which considers the prevalence of allergic rhinitis in the MCOs to guide formulary inclusion decisions. Managed care decision makers will increasingly need to request this information from drug manufacturers if an informed, evidence-based decision is to be made.     

Anisakiasis as a cause of acute appendicitis and rheumatologic picture: the first case in medical literature

We report a case of acute abdomen due to appendicular lumen occlusion by anisakis larvae. This is the first case of human anisakiasis known in Spain, and the first case of acute appendicitis, in the medical World literature, produced by this nemathode. The association of myalgias and arthralgias stands out, being in this aspect the second case found the in medical litterature.     

Renal Transplantation in Second-Level Private Hospitals in the State of Mexico

Background

Kidney transplantation (KT) is the replacement therapy of choice in patients with end-stage renal disease (ESRD). Here we show a cohort of kidney transplant recipients from the period of May 1994 to May 2016 in 2 2nd-level private hospitals from the city of Toluca in the state of Mexico.

Bone metastases from unknown primary. FDG-PET detection of two synchronous tumors

A 60-year-old woman presented with noncardiac chest pain over months and negative laboratory findings. Conventional imaging methods and bone scintigraphy detected bone lesions suggesting metastatic disease from an unknown primary tumor. An 18FDG-PET scan performed to orient the search for the primary tumor found focal lesions suggesting lymphoma and identified a focal thyroid lesion and a cervical lymph node accessible for biopsy. The biopsy of this lymph node incidentally detected a papillary differentiated thyroid cancer (DTC), since the existence of a non-Hodgkin's lymphoma was confirmed after a new biopsy. After confirming the presence of a lymphoma, 18FDG-PET enabled the initial staging of the tumor, the evaluation of the response to treatment, and follow-up for detection of recurrence. On the other hand, 18FDG-PET incidentally detected a DTC.     

Videothorascocopic: approach in thoracic inlet of neurogenic mediastinal tumor in pediatric age

We present a 4 year-old patient with precedent of pneumonia and showing an increase of X-ray density in the superior mediastinal. After a year of follow-up and the presence of irritating cough, it is decided to perform studies of image (CT), being diagnosed of a mass in the region of the thoracic inlet which affects up to D4. Video-assisted thoracic surgery is decided and the mass is entirely removed, being the result of the pathological study to ganglioneuroma. Eight months later from, the patient is asymptomatic and without relapse according to the image methods which were carried out.