ABSTRACT Pulmonary alveolar proteinosis (PAP) is a rare lung disease with an incidence of 0.2 cases per million. PAP has multiple causes, including autoimmune, hereditary, congenital, or secondary. The latter includes hematologic conditions and exposure to different kinds of dust. Most patients present fever, dyspnea, and cough. The chest computed tomography (CT) may reveal the crazy-paving polygonal shapes with superimposed ground glass opacities delimited by thickened interlobular septa; however, this finding is more prevalent in patients with autoimmune PAP. Bronchoalveolar lavage (BAL) shows a milky-opaque appearance with PAS-positive debris on cytology. Treatment is focused on the underlying disease; however, some patients may require whole lung lavage for symptomatic management. We report a case of a 30-year-old female with a history of familial myelodysplastic syndrome (MDS) with GATA 2 mutation who presented to the outpatient clinic with several months of progressive dyspnea and nonproductive cough. The chest CT revealed bilateral ground-glass opacities prominently in the upper lobes. She underwent a bronchoscopy with lavage and biopsy, which revealed fragments of lung parenchyma with intra-alveolar coarse granular eosinophilic material strongly positive for PAS and d-PAS. The overall clinical presentation and histologic findings were diagnostic of PAP. Her GM-CSF was negative, and due to her history of MDS, secondary PAP (S-PAP) was strongly suspected. She underwent a successful allogeneic bone marrow pluripotent stem cell transplant to treat the myelodysplastic syndrome, with a follow-up chest CT showing clear lung parenchyma. The patient had resolution of symptoms about four months after the bone marrow transplant, confirming the diagnosis of S-PAP.

Abstract: This article examines the impact of Seguro Popular (SP) in health services utilization, in the labor market, and in household health expenditures. Benefiting from longitudinal data from the Mexican Family Life Survey, we use propensity score matching techniques to analyze the data by gender and population origin. In general, the SP has not impacted the number of hospitalizations and out-patient consultations, with the exception of urban women. The analysis by institution shows that, in urban populations, the SP has increased external consultations in the health care facilities provided by the Health Ministry. The SP shows a negative impact in the Mexican Institute of Social Security coverage, and in the formal employment of urban women and rural men. At the household level, we do not find any effect on household health expenditures.

Resumen: Este artículo examina el impacto del Seguro Popular (SP) en la utilización de servicios de salud, en el gasto de los hogares en salud y en el mercado laboral. El análisis se realiza por género y origen de la población (urbano y rural) utilizando datos longitudinales de la Encuesta Nacional sobre Niveles de Vida de los Hogares (ENNViH), y el método de emparejamiento de marcadores de propensión. En general, se observa que el SP no ha tenido un impacto en el número de hospitalizaciones y consultas externas, con excepción de las mujeres de origen urbano. El análisis por institución muestra que el SP ha provocado un incremento en la consulta ofrecida en establecimientos de la Secretaría de Salud (SSA) en poblaciones urbanas. Adicionalmente, se observa que el SP ha tenido un impacto negativo en la cobertura del Instituto Mexicano del Seguro Social (IMSS) y en el empleo formal de las mujeres de origen urbano, y de los hombres de origen rural. En el ámbito del hogar, no se encuentra ningún impacto en el gasto en salud.