Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 6 Articles
Background: We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT;\r\nfluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall\r\nmortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes\r\n(MDS). The perspective was that of the Spanish National Health Service (NHS).\r\nMethods: A decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, lifeyears\r\nsaved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS) over patientsââ?¬â?¢\r\nlifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the\r\ndrugs (in euros at November 2009 values) which were obtained from the published literature and opinions of an\r\nexpert committee. A probabilistic sensitivity analysis (PAS) was performed.\r\nResults: Posaconazole was associated with fewer IFI (0.05 versus 0.11), increased LYS (2.52 versus 2.43), and\r\nsignificantly lower costs excluding costs of the underlying condition (ââ??¬6,121 versus ââ??¬7,928) per patient relative to\r\nSAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97%\r\nprobability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of ââ??¬30,000 currently\r\naccepted in Spain.\r\nConclusions: Posaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy) compared with\r\nfluconazole or itraconazole in high-risk neutropenic patients....
Background: Serologic testing algorithms for recent HIV seroconversion (STARHS) provide important information\r\nfor HIV surveillance. We have previously demonstrated that a patientââ?¬â?¢s antibody reaction pattern in a confirmatory\r\nline immunoassay (INNO-LIAââ??¢ HIV I/II Score) provides information on the duration of infection, which is unaffected\r\nby clinical, immunological and viral variables. In this report we have set out to determine the diagnostic\r\nperformance of Inno-Lia algorithms for identifying incident infections in patients with known duration of infection\r\nand evaluated the algorithms in annual cohorts of HIV notifications.\r\nMethods: Diagnostic sensitivity was determined in 527 treatment-naive patients infected for up to 12 months.\r\nSpecificity was determined in 740 patients infected for longer than 12 months. Plasma was tested by Inno-Lia and\r\nclassified as either incident (< = 12 m) or older infection by 26 different algorithms. Incident infection rates (IIR)\r\nwere calculated based on diagnostic sensitivity and specificity of each algorithm and the rule that the total of\r\nincident results is the sum of true-incident and false-incident results, which can be calculated by means of the predetermined\r\nsensitivity and specificity.\r\nResults: The 10 best algorithms had a mean raw sensitivity of 59.4% and a mean specificity of 95.1%. Adjustment\r\nfor overrepresentation of patients in the first quarter year of infection further reduced the sensitivity. In the\r\npreferred model, the mean adjusted sensitivity was 37.4%. Application of the 10 best algorithms to four annual\r\ncohorts of HIV-1 notifications totalling 2ââ?¬â?¢595 patients yielded a mean IIR of 0.35 in 2005/6 (baseline) and of 0.45,\r\n0.42 and 0.35 in 2008, 2009 and 2010, respectively. The increase between baseline and 2008 and the ensuing\r\ndecreases were highly significant. Other adjustment models yielded different absolute IIR, although the relative\r\nchanges between the cohorts were identical for all models.\r\nConclusions: The method can be used for comparing IIR in annual cohorts of HIV notifications. The use of several\r\ndifferent algorithms in combination, each with its own sensitivity and specificity to detect incident infection, is\r\nadvisable as this reduces the impact of individual imperfections stemming primarily from relatively low sensitivities\r\nand sampling bias....
Background: To probe seroepidemiology of the 2009 pandemic influenza A (H1N1) among health care workers\r\n(HCWs) in a children�s hospital.\r\nMethods: From August 2009 to March 2010, serum samples were drawn from 150 HCWs in a children�s hospital in\r\nTaipei before the 2009 influenza A (H1N1) pandemic, before H1N1 vaccination, and after the pandemic. HCWs who\r\nhad come into direct contact with 2009 influenza A (H1N1) patients or their clinical respiratory samples during\r\ntheir daily work were designated as a high-risk group. Antibody levels were determined by hemagglutination\r\ninhibition (HAI) assay. A four-fold or greater increase in HAI titers between any successive paired sera was defined\r\nas seroconversion, and factors associated with seroconversion were analyzed.\r\nResults: Among the 150 HCWs, 18 (12.0%) showed either virological or serological evidence of 2009 pandemic\r\ninfluenza A (H1N1) infection. Of the 90 unvaccinated HCWs, baseline and post-pandemic seroprotective rates were\r\n5.6% and 20.0%. Seroconversion rates among unvaccinated HCWs were 14.4% (13/90), 22.5% (9/40), and 8.0% (4/\r\n50) for total, high-risk group, and low-risk group, respectively. Multivariate analysis revealed being in the high-risk\r\ngroup is an independent risk factor associated with seroconversion.\r\nConclusion: The infection rate of 2009 pandemic influenza A (H1N1) in HCWs was moderate and not higher than\r\nthat for the general population. The majority of unvaccinated HCWs remained susceptible. Direct contact of\r\ninfluenza patients and their respiratory samples increased the risk of infection...
Background: Bloodstream infections (BSI) have been traditionally classified as either community acquired (CA) or\r\nhospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community onset disease\r\nhas been increasingly recognized. The objective of this study was to compare and contrast characteristics of HCABSI\r\nwith CA-BSI and HA-BSI.\r\nMethods: All first episodes of BSI occurring among adults admitted to hospitals in a large health region in Canada\r\nduring 2000-2007 were identified from regional databases. Cases were classified using a series of validated\r\nalgorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic, microbiologic,\r\nand outcome characteristics.\r\nResults: A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088 (40%) had\r\nCA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical illnesses than\r\npatients with HCA-BSI or HA-BSI (p < 0.001). The proportion of cases in males was higher for HA-BSI (60%; p <\r\n0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54%; p = 0.13). The proportion of cases that had a\r\npoly-microbial etiology was significantly lower for CA-BSI (5.5%; p < 0.001) compared to both HA and HCA (8.6 vs.\r\n8.3%). The median length of stay following BSI diagnosis 15 days for HA, 9 days for HCA, and 8 days for CA (p <\r\n0.001). Overall the most common species causing bloodstream infection were Escherichia coli, Staphylococcus\r\naureus, and Streptococcus pneumoniae. The distribution and relative rank of importance of these species varied\r\naccording to classification of acquisition. Twenty eight day all cause case-fatality rates were 26%, 19%, and 10% for\r\nHA-BSI, HCA-BSI, and CA-BSI, respectively (p < 0.001).\r\nConclusion: Healthcare-associated community onset infections are distinctly different from CA and HA infections\r\nbased on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds further support\r\nfor the classification of community onset BSI into separate CA and HCA categories....
Background: Chronic hepatitis C (HCV) disease can be complicated with comorbid conditions that may impact\r\ntreatment eligibility and outcomes. The aim of the study was to systematically review comorbidities and symptoms\r\nin an HCV infected population, specifically assessing comorbidities associated with HCV anti-viral treatment and\r\ndisease, as well as comparing comorbidities between an HCV infected and uninfected control population.\r\nMethods: This was a retrospective cohort study within a United States medical claims database among patients\r\nwith chronic HCV designed to estimate the two-year period prevalence of comorbidities. Patients with two HCV\r\ndiagnosis codes, 24 months of continuous health insurance coverage, and full medical and pharmacy benefits\r\nwere included.\r\nResults: Among a chronic HCV cohort of 7411 patients, at least one comorbid condition was seen in almost all\r\npatients (> 99%) during the study period. HCV-infected patients reported almost double the number of\r\ncomorbidities compared to uninfected controls. Of the 25 most common comorbidities, the majority of the\r\ncomorbidities (n = 22) were known to be associated with either HCV antiviral treatment or disease. The five most\r\nfrequent comorbidities were liver disease [other] (37.5%), connective tissue disease (37.5%), abdominal pain (36.1%),\r\nupper respiratory infections (35.6%), and lower respiratory disease (33.7%). Three notable comorbidities not known\r\nto be associated with antiviral treatment or disease were benign neoplasms (24.3%), genitourinary symptoms & illdefined\r\nconditions (14.8%), and viral infections (13.8%).\r\nConclusions: This US medically insured HCV population is highly comorbid. Effective strategies to manage these\r\ncomorbidities are necessary to allow wider access to HCV treatment and reduce the future burden of HCV disease\r\nand its manifestations....
The various synthetic varieties of chicken evolved for Backyard rearing Viz., Rajasri, Vanaraja, Gramapriya and other exotic populations like pure RIR, Delham Red, Kadaknath along with the Native chicken, Aseel were utilized for conducting the Humoral and Cell mediated immune responses. The mean values of Haemagglutination titers estimated at 7th and 15th day of post inoculation of SRBC, expressed as log2 values among all the breeds under the study ranged from 2.07 to 5.48 and 0.65 to 2.85 respectively. The Rajasri breed is found to be significantly superior showing the higher HA titers values (5.48 and 2.85) at 7th and 15th day, compared to Gramapriya (3.38 and 2.74) and Vanaraja breeds (3.73 and 1.91). Among the pure lines these values were 2.60 and 0.65, 2.63 and 0.92 and 2.18 and 2.00 in RIR, Delham Red and Kadaknath breeds at 7th and 15th day of post inoculation respectively. Among the Native chickens Aseel breed has shown more titers (4.00 and 2.19), over the country chicken (3.84 and 1.00) at respective ages. Bantam breed recorded the titer value of 4.04 and 2.33 at 7th and 15th day of post inoculation. ILR-90 Jubilee (IWDxIWF) recorded lowest titer value (2.07) at 7th day among the breeds under testing. The cell mediated immunity values estimated as Foot pad index (mm) among different breeds ranged from 0.08 to 0.21mm. The correlations between HA-7 and FPI was positive and ranged from -0.32 to 0.65....
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