RESUMO
PURPOSE: Our purpose was to use real world data to assess trends in radiation therapy (RT) treatment fractionation and cost under the Oncology Care Model (OCM) through the first 8 performance periods (PPs). METHODS: We identified 17,157 episodes of care from 9898 patients treated at a statewide multispecialty health system through the first 8 6-month PPs (PP1-8: July 1, 2016, to June 30, 2020) of the OCM. Spending was stratified by 10 expenditure domains (eg, Part B/D drugs, radiation oncology [RO], etc), and 21 disease sites were extracted from claims data, from which an analysis of RO expenditures was performed on 2219 episodes from 2033 patients treated with RT. Expenses are expressed in per-beneficiary, per-episode terms. RESULTS: RO expenditures comprised 3% ($14.7M) of total spending over the 8 periods. By primary cancer, the largest RO expenses were for breast ($2.9M; 20%), prostate ($2.9M; 19%), and lung cancer ($2.8M; 13%). For RO, total per-episode average spending remained roughly constant between PP1 ($6314) and PP8 ($6664; Ptrend > .05) and decreased ($6314-$6215) when indexed to the Consumer Price Index for July 2016. Average number of RT fractions per episode decreased from 19.2 in PP1 to 18.6 in PP8; this decrease was most notably seen for breast (-2.1), lung (-2.8), and female genitourinary (-3.5) cancers. Intensity-modulated RT (IMRT) charges accounted for $7.6M (51%) of RT spending and increased 5% from PP1 to 8, whereas conventional external beam RT made up $3.0M (21%) and decreased 8%. Expenses for image guidance ($2.5M; 17%; +2% from PP1-8) and stereotactic RT ($1.3M; 9%; +1%) increased. CONCLUSIONS: In inflation-adjusted terms, total RO expenditures have declined despite greater use of IMRT, stereotactic RT, and image guidance. Conversely, oncology costs have risen because of drug spending. Successful payment models must prioritize high-cost spending areas-including novel drug therapies-while accounting for high-value care and patient outcomes.
Assuntos
Neoplasias Pulmonares , Radioterapia (Especialidade) , Masculino , Humanos , Feminino , Estados Unidos , Gastos em Saúde , Oncologia , MedicareRESUMO
PURPOSE: The Radiation Oncology Alternative Payment Model (RO Model) will test prospective radiotherapy episode-based payments for 16 common disease sites. We created an automated analytics platform to calculate the impact of the RO Model vs historical fee-for-service episode reimbursements for brachytherapy treatments within five community oncology practices for prostate, uterine, and cervical cancer. METHODS AND MATERIALS: Claims data between January 1, 2017 and October 2, 2019 for prostate, uterine, and cervical cancer were analyzed as per the RO Model Final Rule methodology. Expected professional and technical component (PC and TC) reimbursements were compared for episodes that utilized brachytherapy alone vs combination modality (external beam and brachytherapy) in the RO Model vs historical reimbursements. RESULTS: 6,022 RO Model-defined episodes (60% prostate, 28% uterine, 13% cervical) were generated. Brachytherapy monotherapy episodes (14%) would have an average positive reimbursement in the RO Model (+$2,163 for prostate, +$711 for uterine, +$533 for cervical for the PC; +$12,168 for prostate, +$8,181 for uterine, +$11,322 for cervical for the TC), while combination modality episodes (15%) would have an average negative reimbursement in the RO Model (-$183 for prostate, -$1,701 for uterine, -$2,195 for cervical for the PC; -$374 for prostate, -$5,026 for uterine, -$2,801 for cervical for the TC). CONCLUSIONS: Brachytherapy monotherapy episodes for prostate, uterine, and cervical cancer will benefit from an increase in payment, whereas combination modality episodes will receive lower reimbursement. Large shifts in episodic payment may be related to practice-wide adjustments and pricing based on partial episodes of care that may ultimately limit access to care for vulnerable patient populations with cancer.
Assuntos
Braquiterapia , Radioterapia (Especialidade) , Neoplasias do Colo do Útero , Braquiterapia/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Neoplasias do Colo do Útero/radioterapiaRESUMO
AIMS: Characterization of quinolone-resistant Salmonella Kentucky and Typhimurium isolates in Tunisia from various sources, detection of some plasmid-mediated quinolone resistance genes and the genetic relatedness. METHODS: A total of 1404 isolates of S. Kentucky (n = 1059)/S. Typhimurium (n = 345) from various sources from all over Tunisia were tested for quinolone resistance by disk diffusion method. Minimum inhibitory concentrations of nalidixic acid, ciprofloxacin and ofloxacin were determined. Quinolone-resistant isolates were screened for plasmid-mediated quinolone-resistance genes (qnrA,qnrB,qnrS, aac(6')-Ib-cr and qepA) by polymerase chain reaction (PCR). Mutations in the quinolone-resistance-determining regions of the gyrA and parC genes were detected by PCR and DNA sequencing. Pulsed-field gel electrophoresis and multilocus sequence typing were accomplished for isolates harbouring plasmid-mediated quinolone-resistance genes. RESULTS: According to our selection criteria (NAL = resistance phenotype; CIP = resistant with diameter 0, or intermediate), only 63 S. Kentucky/41 S. Typhimurium isolates were investigated: 49% (5/104) were multidrug resistant. Two S. Typhimurium isolates harboured qnrB19 with different PFGE profiles. A mutation was detected in the gyrA gene for each of these two isolates. MLST revealed the presence of ST313 and ST34, an endemic sequence type. CONCLUSION: Our study highlights the presence of quinolone multidrug-resistant Salmonella in humans and animals in Tunisia. This is the first report of S. Typhimurium ST34 in Africa and qnrB19 in Tunisia. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report that describes not only the current epidemiological situation of the quinolone resistance in S. Kentucky and Typhimurium isolated from various sources and regions in Tunisia, but also, the genetic resistance determinants associated with phenotypic antibiotic resistance and the molecular mechanisms of their quinolone-resistance. Also, we provide the first report of S. Typhimurium ST34 in Africa, and the first report of qnrB19 in Salmonella in Tunisia.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Quinolonas/farmacologia , Salmonella typhimurium/efeitos dos fármacos , Salmonella/efeitos dos fármacos , Animais , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Mutação , Plasmídeos/genética , Salmonella/genética , Salmonella/isolamento & purificação , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/microbiologia , Salmonella typhimurium/genética , Salmonella typhimurium/isolamento & purificação , Tunísia/epidemiologiaRESUMO
Purpose. Acute bacterial meningitis continues to be a potentially life threatening condition. Hospital-acquired meningitis is rapidly increasing and adding an immense burden to the health system due to the emergence of multidrug resistance isolates. The purpose of this study is to find the antibiotic susceptibility pattern of the bacteria detected from hospital- and community-acquired meningitis.Methodology. A total of 400 Cerebrospinal fluid (CSF) samples from the suspected meningitis cases were collected and processed for cell count, biochemical examination, Gram staining, latex agglutination and culture. Bacteria grown on blood, chocolate and Mac-conkey agar were identified by matrix-assisted laser desorption/ionization-time of flight. Antibiotic susceptibility tests were performed as per Clinical and Laboratory Standard Institute guidelines.Results. Of the isolates, most prevalent Gram negative organisms in hospital-acquired bacterial meningitis were Escherichia coli 13 (27.08â%), Acinetobacter baumannii 12 (25â%), Klebsiella pneumoniae 5 (10.42â%), Pseudomonas aeruginosa 4 (8.33â%) and Gram positive organisms were Staphylococcus aureus 4 (8.33â%), Enterococcus faecium 3 (6.25â%) and CONS 2 (4.16â%). Streptococcus pneumoniae 3 (6.25â%) was the predominant organism in community-acquired bacterial meningitis. All the Gram negative isolates were multidrug resistance. Only colistin and imipenem were effective antibiotics against them. Likewise Gram positive organisms were susceptible to most of the antibiotics tested. However, E. faecium was only susceptible to Vanco+Teicoplanin.Conclusion. In hospital-acquired bacterial meningitis, multidrug resistance Gram negative bacteria are a huge challenge for the treatment of patients. Hence, antimicrobial stewardship should be followed to counteract with the emerging multidrug resistance isolates.
Assuntos
Bactérias/efeitos dos fármacos , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Meningites Bacterianas/microbiologia , Antibacterianos/farmacologia , Gestão de Antimicrobianos , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Colistina/farmacologia , Humanos , Imipenem/farmacologia , Índia , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária/estatística & dados numéricos , Vancomicina/farmacologiaRESUMO
Assuntos
Lipopolissacarídeos/urina , Sistemas Automatizados de Assistência Junto ao Leito , Tuberculose Pulmonar/diagnóstico , Adolescente , Criança , Serviços de Saúde da Criança , Pré-Escolar , Feminino , Humanos , Índia , Lactente , Masculino , Técnicas de Diagnóstico Molecular , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/isolamento & purificação , Sensibilidade e Especificidade , Tuberculose Pulmonar/urina , UrináliseRESUMO
In this study, we have designed and developed two series of bifunctional conjugates by tethering polyethylenimine with streptomycin. By varying the amount of streptomycin, conjugates, polyethylenimine-streptomycin, have been synthesized and characterized spectroscopically. Gel electrophoresis assay revealed a slight decrease in the cationic charge density on the conjugates as these retarded the mobility of pDNA at higher w/w ratios. Further, transfection studies showed that both the series of conjugates transfected the mammalian cells efficiently with low-molecular weight polyethylenimine-streptomycin conjugates were more competent (â¼9-fold enhancement with respect to native bPEI) exhibiting high cell viability too. Besides, both the series of conjugates displayed excellent antibacterial activity on pathogenic bacteria, even better than native streptomycin on resistant strains. Altogether, these results ensure the promising potential of the projected bifunctional conjugates as safe and efficient gene delivery vectors as well as antibacterials for future biomedical applications.
Assuntos
Antibacterianos/química , DNA/administração & dosagem , Portadores de Fármacos/química , Técnicas de Transferência de Genes , Polietilenoimina/análogos & derivados , Estreptomicina/análogos & derivados , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/prevenção & controle , DNA/genética , Portadores de Fármacos/farmacologia , Células HEK293 , Humanos , Polietilenoimina/farmacologia , Estreptomicina/farmacologia , Transfecção/métodosRESUMO
Present work was inspired by an interesting finding of Raithel et al. (11) about remission of steroid-dependent, chronically active ulcerative colitis (UC) in a patient, after treatment with a combination of fexofenadine, disodium cromoglycate and an amino acid-based formula. Literature reports involvement of mast cells activation and increased histamine secretion in the pathogenesis of colitis. The purpose of present work was to evaluate the potential of a novel prodrug of fexofenadine in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. A colon-specific mutual amide prodrug of fexofenadine with D-glucosamine was synthesized. Release was studied in tissue homogenates and rat fecal matter by HPLC. It was further screened in TNBS-induced colitis in rats and also for adverse effects on rat liver, stomach and pancreas. The spectral analysis confirmed the structure of the prodrug. Highly hydrophilic prodrug enabled efficient delivery of fexofenadine to colon. Prodrug furnished negligible release of fexofenadine in upper gastrointestinal tract (GIT) homogenates. About 82% release of fexofenadine was observed in rat fecal matter at the end of 12 hours. The prodrug was twice as effective in lowering the quantifying parameters of colonic inflammation in TNBS- induced colitis than fexofenadine, D-glucosamine, their physical mixture and interestingly oral 5-amino salicylic acid while 2.7 times less effective than sulfasalazine. The prodrug restored disrupted colonic architecture to normal without adversely affecting stomach, liver and pancreas. In conclusion, the results support histamine involvement in the pathogenesis of UC. This novel, dual acting colon-specific prodrug of fexofenadine is promising as combination maintenance therapy with sulfasalazine for UC.
Assuntos
Amidas/administração & dosagem , Colite Ulcerativa/tratamento farmacológico , Glucosamina/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Pró-Fármacos/administração & dosagem , Terfenadina/análogos & derivados , Animais , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/patologia , Colo , Fígado/anatomia & histologia , Fígado/efeitos dos fármacos , Masculino , Pâncreas/anatomia & histologia , Pâncreas/efeitos dos fármacos , Ratos , Ratos Wistar , Estômago/anatomia & histologia , Estômago/efeitos dos fármacos , Terfenadina/administração & dosagem , Ácido TrinitrobenzenossulfônicoRESUMO
The study was done to determine the anti-tuberculosis drug resistance patterns of Mycobacterium tuberculosis (MTB) in AIDS patients. Fifty antiretroviral drug naïve new AIDS patients with clinical evidence of pulmonary tuberculosis and no previous history of tuberculosis were recruited. Baseline CD4 counts and plasma viral loads (PVL) were measured by flow cytometry and RT-PCR, respectively. Sputum samples were obtained from each patient and subjected to Ziehl-Neelsen staining and cultured on Lowenstein-Jensen medium and using the BACTEC 460 system (B460). Antimicrobial susceptibilities were tested in all isolates using the B460 gystem. The occurrence of MTB was found to be more common with a PVL>4 log10 copies/ml (odds ratio: 4.6). Of 15 MTB isolates, 8 (53.3%) had single drug resistance, 4 (26.7%) had multidrug resistance (MDR) and 1 (6.7%) had resistance to three drugs (non-MDR). Two isolates (13.3%) were sensitive to all the four drugs. Resistance to first line anti-tuberculosis drugs was found to be higher among AIDS patients with MTB.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Antibacterianos/farmacologia , Antituberculosos/uso terapêutico , Contagem de Linfócito CD4 , Farmacorresistência Bacteriana Múltipla , Etambutol/farmacologia , Feminino , Humanos , Índia/epidemiologia , Isoniazida/farmacologia , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rifampina/farmacologia , Escarro/microbiologia , Estreptomicina/farmacologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia , Carga ViralRESUMO
The aim of this study was to determine the clinical, immunological and virological status of newly diagnosed AIDS cases and to monitor their clinical and immunological response to HAART after a minimum period of three months. Forty three drug naive AIDS patients were enrolled. The most common presenting complaints were weight loss (74.4%), cough (72.1%) and diarrhoea (67.4%). Mean baseline CD4 cell count was 112 +/- 60 cells/microL and mean baseline plasma viral load of 31 patients studied was 192,686 copies/mL. Baseline plasma viral load was higher among patients with lower baseline CD4 cell count. During follow-up, 80.8% patients showed clinical improvement, while a CD4 cell count increased by > or =50 cells/microL in 84.6% cases. Mean CD4 cell count increased from 126 +/- 16.6 cells/microL at baseline to 278 +/- 196.7 cells/microL.
Assuntos
Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/virologia , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Carga Viral , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Seguimentos , Humanos , Estatística como AssuntoRESUMO
Lectin activities in roots, nodules, stems and leaves of 1-6 week old peanut plant (A. hypogaea) were checked by erythrocyte (human and rabbit) agglutination and sugar inhibition assays. Human and rabbit erythrocyte agglutinating activities were specifically inhibited by lactose/cellobiose (SLII) and methyl alpha-mannoside (SLI) respectively. Seeds, embryos and cotyledons agglutinated neuraminidase treated human erythrocytes and that activity was inhibited by T-disaccharide. In the roots of field grown plants SLI was the major activity, while nodules showed both activities (SLI and SLII). Specific activities of SLI and SLII were maximal in stem tissue and hypocotyl exhibited minimal levels. Actively growing tissues like newly emerging young leaves and elongating stem contained more SLII activity in comparison to the mature tissues. Immunological test indicated that all the vegetative tissue lectins are serologically related.