Cost-effectiveness of a post-splenectomy registry for prevention of sepsis in the asplenic

Background: Overwhelming, sometimes fatal infections represent a lifelong risk after surgical removal of the spleen, or in patients who develop hyposplenism as a consequence of illnesses. This risk may be reduced by all or a combination of vaccination, antibiotic prophylaxis and education. We aimed to determine if a registry approach to delivering these interventions would be cost effective using our own experience and published data.
Method: The decision model compared a cohort of 1,000 people covered by a registry to a cohort of 1,000 people with no registry. The impact of the registry was assessed in terms of achieved rates of vaccination, chemoprophylaxis and education, consequent outcomes of overwhelming post-splenectomy infection (OPSI) and mortality (years of life lived). The cost-effectiveness of the registry compared with no registry was estimated in terms of additional cost per case of OPSI avoided and as additional cost per life year gained.
Results: In the first two years, the additional cost of the registry was $152,611 per case of OPSI avoided or $205,931 per life year gained. After this initial registration period the costeffectiveness improves over time, such that over the cohort lifetime a post-splenectomy register is associated with an additional cost of $105,159 per case of OPSI avoided or $16,113 per life year gained.
Conclusion: A registry-based approach is likely to prove cost effective in terms of mortality and rates of OPSI avoided.

Modelagem molecular na caracterização eletrônica de oligopeptídeos e na descrição quântica da interação fármaco-receptor

In this dissertation, the theoretical principles governing the molecular modeling were applied for electronic characterization of oligopeptide α3 and its variants (5Q, 7Q)-α3, as well as in the quantum description of the interaction of the aminoglycoside hygromycin B and the 30S subunit of bacterial ribosome. In the first study, the linear and neutral dipeptides which make up the mentioned oligopeptides were modeled and then optimized for a structure of lower potential energy and appropriate dihedral angles. In this case, three subsequent geometric optimization processes, based on classical Newtonian theory, the semi-empirical and density functional theory (DFT), explore the energy landscape of each dipeptide during the search of ideal minimum energy structures. Finally, great conformers were described about its electrostatic potential, ionization energy (amino acids), and frontier molecular orbitals and hopping term. From the hopping terms described in this study, it was possible in subsequent studies to characterize the charge transport propertie of these peptides models. It envisioned a new biosensor technology capable of diagnosing amyloid diseases, related to an accumulation of misshapen proteins, based on the conductivity displayed by proteins of the patient. In a second step of this dissertation, a study carried out by quantum molecular modeling of the interaction energy of an antibiotic ribosomal aminoglicosídico on your receiver. It is known that the hygromycin B (hygB) is an aminoglycoside antibiotic that affects ribosomal translocation by direct interaction with the small subunit of the bacterial ribosome (30S), specifically with nucleotides in helix 44 of the 16S ribosomal RNA (16S rRNA). Due to strong electrostatic character of this connection, it was proposed an energetic investigation of the binding mechanism of this complex using different values of dielectric constants (ε = 0, 4, 10, 20 and 40), which have been widely used to study the electrostatic properties of biomolecules. For this, increasing radii centered on the hygB centroid were measured from the 30S-hygB crystal structure (1HNZ.pdb), and only the individual interaction energy of each enclosed nucleotide was determined for quantum calculations using molecular fractionation with conjugate caps (MFCC) strategy. It was noticed that the dielectric constants underestimated the energies of individual interactions, allowing the convergence state is achieved quickly. But only for ε = 40, the total binding energy of drug-receptor interaction is stabilized at r = 18A, which provided an appropriate binding pocket because it encompassed the main residues that interact more strongly with the hygB - C1403, C1404, G1405, A1493, G1494, U1495, U1498 and C1496. Thus, the dielectric constant ≈ 40 is ideal for the treatment of systems with many electrical charges. By comparing the individual binding energies of 16S rRNA nucleotides with the experimental tests that determine the minimum inhibitory concentration (MIC) of hygB, it is believed that those residues with high binding values generated bacterial resistance to the drug when mutated. With the same reasoning, since those with low interaction energy do not influence effectively the affinity of the hygB in its binding site, there is no loss of effectiveness if they were replaced.

CAMPYLOBACTER EM CAES COM E SEM DIARREIA: INCIDENCIA E SUSCETIBILIDADE A 21 ANTIMICROBIANOS

Two hundred and four stools of 102 diarrheic (0-12 months of age) and 102 non-diarrheic dogs coming from kennel and ambulatory, respectively, were assayed for the presence of Campylobacter. From the diarrhetic group, 46% of the samples yelded positive Campylobacter isolation mainly found in young animals until 5 months of age (72%), whereas those with age ranging from 6-12 months showed either a lower frequence of the organisms (28%) and a trend of the younger animals to be more charged than the older. 47 Campylobacter strains isolated from the diarrheic group were: C. jejuni biotype 1 (49%); C. jejuni biotyp 2 (11%); C. jejuni/coli (19%); C. coli (8,5%); Campylobacter NARTC group (8,5%) and C. sputoruns (4%). In the non-diarrhetic group, 27 (28%) Campylobacter strains were classified as: C. jejuni biotype 1 (34%) and biotype 2 (28%); C. jejuni/coli (24%) and C. coli (14%). According the biochemical tests, the 1% glycine tolerance test was not taking in account for the differentiation of C. jejuni because 45% of the strains failed in showing characteristic and 3 strains did not reduce the sodium selenite. The biochemical studies also showed phenotipical cross reactions between two Campylobacter NARTC-group strains with the C. jejuni strains, as well as two thermophilic species grew also at 25°C. All the 76 isolates were sensitive to gentamicin, nitrofurantoin and neomycin and resistant to oxacillin and penicillin. Furthermore, for the remaining 16 drugs the populational resistance ranged from 8% to 73% of strains. The presence of Campylobacter in dogs as well their close contact which man makes possible the occurrence of infections as also confirm the campylobacteriosis as an important zoonosis.

AVALIACAO DO EFEITO DO VENENO DE APIS MELLIFERA EM CULTURAS DE E. COLI, S. TYPHIMURIUM E Y. ENTEROCOLITICA TRATADAS COM BLEOMICINA

Apis mellifera bee venom (Africanized honey bee) was tested for the ability to protect against the lethal effect of bleomycin, an antibiotic and antineoplastic agent. Since the radioprotective effect of the venom has been observed on the other biological systems, in the present study the venom was applied to cultures of enterobacteria treated with bleomycin, a radiomimetic agent. The venom did not act as a protective agent against bleomycin in E. coli, S. typhimurium or Y. enterocolitica.

Estudo sobre a resistencia aos antimicrobianos em bacterias isoladas de pacientes hospitalizados (Botucatu, 1988-1992)

Since 1988 to 1992, a study about susceptibility to antimicrobial drugs of bacterias isolated from hospitalized patients was performed. The compared susceptibility to important drugs (ampicillin, cephalotin, cefoxitin, ceftaxizime, ceftriaxone, aztreonam, gentamicin, amikacin, pefloxacin, ciprofloxacin, imipenem, oxacillin and vancomycin) was investigated in 1200 strains (300 of each specie) of the prevalent bacterias: E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. aureus. Minimal inhibitory concentration (MIC) was determined by agar dilution method, using from 0.05 to 256 mcg of each drug per ml of culture medium (Mueller-Hinton). Ranges of MIC, MIC(50%), MIC(90%) and the proportion of resistant strains were determined and permitted to know the 4 drugs that were found to be more active against bacterias; the CIM(90%) values are: E. coli - aztreonam (0.1 mcg/ml), pefloxacin (0.1), ceftazidime (0.25) and ceftriaxone (0.05); K. pneumoniae-aztreonam (0.25) ceftriaxone (0.25), ceftazidime (0.5) and pefloxacin (2.0); P. aeruginosa-imipenem (4.0), aztreonam (16), ceftazidime (16) and ciprofloxacin (16); S. aureus-vancomycin (1.01, ciprofloxacin (8, 0), amikacin (128) and cephalothin (128 mg/ml). The better 'in vitro' antibacterial activity observed was related to: aztreonam (77-100% of the sensitive strains), ceftazidime (50-99,7%), pefloxacin (73-99,7%), ciprofloxacin (80%), imipenem (93%) and vancomycin (100%).

FATORES RELACIONADOS COM A OCORRENCIA E EVOLUCAO DAS ENDOFTALMITES

We retrospectively analysed 33 endophthalmitis patients treated at the Faculdade de Medicina de Botucatu. We observed that 81,8% of these patients were males and older than 60 years. Trauma was the main cause of endophthalmitis (42,4%). Endophthalmitis severity can be assessed by the fact there was no improvement on the final visual acuity.

Fermentacao de 26-deoxilaidlomicina por Streptomyces sp. Ar386

In a previous work a strain of microorganism was isolated in Araraquara region, SP, Brazil, and characterized as being Streptomyces sp. Ar386, producer of 26-deoxylaidlomycin and of more three polietheric antibiotics. In this paper there are presented studies about fermentation characteristics of the antibiotic performed in incubator agitator utilizing various cultivation technics and media. A medium containing part of energy source as free sugar and part as amilaceous material presented the best result. As the Streptomyces sp. Ar386 produced few spores, it was necessary special care to provide sufficient quantity of microorganisms in inoculation. The biosynthesis of antibiotics intensified between the forth and seventh day. The yields varied from 8 to 443 mg of antibiotic complex per litre of medium. As a polyether antibiotic it may be used as anticoccidal agent in poultry and as growth promoters in cattle and swine.

Performance characteristics of bioassay, UV-spectrophotometry and high performance liquid chromatographic determination of sparfloxacin in tablets

The microbiological bioassay, the UV-spectrophotometry and the high performance liquid chromatography (HPLC) methods for assaying sparfloxacin in tablets were compared. The accuracy, repeatability, and precision of each method was assessed and precise. All methods were reliable within acceptable limits for antibiotic pharmaceutical preparations being accurate and precise. The microbiological bioassay and HPLC are more specific than UV-spectrophotometric analysis. However, the microbiological bioassay requires 20 h to get results, and HPLC is the most expensive analysis. The application of each method as a routine analysis should be investigated considering cost, simplicity, equipment, solvents, speed, and application to large or small workloads.

Ocorrência e determinação do perfil de sensibilidade às drogas das cepas de Staphylococcus aureus isoladas de fossas nasais e orofaringe dos servidores hospitalares

Staphylococcus aureus is a very important hospital and community pathogen. This species is related to supurative disease, systemic and widespread metastatic lesions. The ability of S. aureus to develop resistance to antibiotics, more recently to methicillin, associates this bacteria with epidemic outbreaks of severe nosocomial infection. The source of staphylococcal infection is a patient with a staphylococcal lesion or a career member of the hospital staff. We aimed to detect the frequency of S. aureus isolated from anterior nares and oral cavities among the hospital staff in Bauru - SP, and to determine the antibiotic susceptibility of the isolates. Within 213 of the staff members analyzed. S. aureus was found in 94 (44.13%) of careers, with 47 (50%) of nasal carriers, 23 (24.4%) of oral carriers and 24 (25.5%) of both carriers. The biochemical characteristics analyzed for the species identification were similar to S. aureus ATCC 29213. All strains identified as S. aureus showed varied sensibility to the antimicrobial agents tested. No vancomicin resistant strains and only 8 (8.5%) strains with oxacilin resistance were found.

Avaliação da prescrição médica em pediatria, baseada nos indicadores do uso de medicamentos selecionados pela oms em municipio do interior do estado de São Paulo

The World Health Organization (WHO) recommends that prescriptions of medicaments must be one parameter utilized to know how the medication is used by people. To do so, one specific methodology has been indicated, that is, the selected indicators of the use the medicaments. We applied this methodology with the aim of presenting a descriptive study of the physician prescription in Pediatric Clinic of the Health Basics Units. The results obtained are: the average number of medicaments prescribed with prescription was 2.6; the percentage of the medicaments prescribed with the generic name was 32%; the percentage of the prescriptions with antibiotics was 44.6%; the percentage of the prescriptions with injections was 10.4%; the percentage of the medicaments prescribed that are part of the municipal list was 22.8%, 27.5% for the program Dose Certs of the secretary of the State of São Paulo, and 50.4% by adding by adding the two lists. The essentiality of the medicaments prescribed may be considered very low, because only 32.6% appear in the RENAME. The percentage of the medicaments really dispensed was 39.9%. The medicaments more prescribed, according to the classification of the Anatomic-Therapeutic-Chemical (ATC), were the ones which acted in Respiratory System (26.8%), followed by anti-infectives for systemic use (16.4%) and by medicaments with acted in Alimentary tract and metabolism (15.8%). The conclusion is that the prescribers are moved by commercial influence of the drug makers, first because of the low prescription of medicaments by their generic name, second by the low number of medicaments effectively dispensed and then the low concordance between the ones prescribed and the ones included in the lists patterned by Tabatinga and by the State of São Paulo.

Antenatal corticosteroid use and clinical evolution of preterm newborn infants

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. Copyright © 2004 by Sociedade Brasileira de Pediatria.

Argon laser for treatment of benign eyelid tumors

Small lesions located in the skin might be treated using the laser system. The purpose of this is to report the therapy of benign eyelid tumors using argon laser. Forty-four benign eyelid tumors were treated using argon blue-green laser with spot size of 500 μm, power from 1000 to 1200 mW and 0.3 second exposure time. The eyelid tumors were located mainly in the upper eyelid (65.9%) and the skin tag was the most frequent treated lesion (43.2%). The average number of laser shots to treat the lesions was 165. There was not observed any complication and all patients were satisfied with the results. The authors are considering the argon laser a benefit therapeutic method to treat benign tumors located in the eyelids.