Estimating the economic effects of cystic echinococcosis. Part 3: Jordan, a developing country with lower-middle income.

The economic costs of cystic echinococcosis (CE) in Jordan, a developing country of lower-middle income, were investigated. Initial cost-estimates for livestock were based on the published prevalences of Echinococcus granulosus infection in sheep and goats and the values of livestock-related products together with likely production losses. Likewise, the annual numbers of human cases of CE were estimated using published surgical incidences in man. The costs of surgery were estimated from hospital records and by costing out the procedures each patient received whilst undergoing treatment. After comparing the quality of life of patients treated for CE with that of case-matched controls, it appeared that the treated patients had some long-term morbidity caused either by the disease or the resulting treatment. A simple spreadsheet model was built up, to sum the individual cost items. Each cost item and each of the data related to prevalence and incidence was assigned a mathematical distribution and varied randomly, using Monte-Carlo techniques, throughout its range, over 10 000 simulations. The results of the study indicate that the most likely range of annual economic losses attributable to CE in Jordan (encompassing 95% confidence limits) is from U.S.$2 602 215-6533 661, with a median of U.S.$3 874 070.

Comparison of 2 techniques for regional antibiotic delivery to the equine forelimb: intraosseous perfusion vs. intravenous perfusion.

The purpose of this study was to compare the synovial fluid concentrations and pharmacokinetics of amikacin in the equine limb distal to the carpus following intraosseous and intravenous regional perfusion. The front limbs of 6 horses were randomly assigned to either intraosseous or intravenous perfusion. A tourniquet was placed distal to each carpus and the limb perfused with 500 mg of amikacin. Systemic blood samples and synovial fluid samples were collected over 70 min from the distal interphalangeal (DIP) joint, metacarpophalangeal joint, and digital flexor sheath. The tourniquet was removed following the 30 min sample collection. The mean peak amikacin concentration for the DIP joint was significantly higher with intravenous perfusion. There were no significant differences in time to peak concentration or elimination half-life between methods at each synovial structure. Each technique produced mean peak concentrations ranging from 5 to 50 times that of recommended peak serum concentrations for therapeutic efficacy.

Estimating the economic effects of cystic echinococcosis. Part 2: an endemic region in the United Kingdom, a wealthy, industrialized economy.

The economic costs of cystic echinococcosis (CE) in Wales, which is part of one of the most highly developed, industrialized countries in the World, were evaluated. In this region, the disease in both sheep and humans causes financial losses. The sheep-related costs in the most highly endemic area, of southern and mid Wales, were estimated from recently published prevalences of the disease in local sheep. No relevant and recent data were available on the sheep in the rest of Wales but these animals were assumed to have lower prevalences, in line with historical data, and were ignored in the economic analysis. The costs of the disease in humans were based on published incidences of human cases treated surgically and the costs of surgery as estimated from hospital records and by costing out the procedures each patient received whilst undergoing treatment. The quality of life of patients treated for CE was also determined and compared with that of healthy, case-matched controls, using a standard health-survey questionnaire (SF-36). The results indicated that the treated patients suffered some long-term morbidity, caused by the disease itself, its treatment or both. Although accurate monetary values were not calculated for this decreased quality of life, the results indicate that the economic effects of human CE are greater than simply the cost of treatment. Assuming that the long-term morbidity demonstrated does have an economic effect, each year CE in Wales is probably costing the U.K. economy more than U.S.$1 million, and perhaps as much as U.S.$7.9 million.

A cross-sectional survey to analyse the risk factors associated with human cystic echinococcosis in an endemic area of mid-Wales.

In mid-Wales, the prevalence of cystic echinococcosis (hydatid disease) in humans and other animals has been well documented. A cross-sectional study was therefore undertaken to examine the associated demographic and environmental risk factors for the disease in humans, in Powys, mid-Wales. Overall, 223 fully completed questionnaires were returned from a postal survey. Eighteen of the respondents had been treated for cystic echinococcosis (CE). No significant association was found between many of the well-established risk factors, such as dog or farm ownership, and treatment for CE, although women were more likely to have been treated for the disease than men.

Risk factors associated with human cystic echinococcosis in Jordan: results of a case-control study.

The parasites causing cystic echinococcosis (CE) are transmitted to man and domestic animals either directly or indirectly from dogs. High levels of human infection have been frequently described in sheep-rearing areas of the world, where the infection cycles between dogs and sheep through the use of working dogs and the feeding of sheep offal to dogs. A case-control study was undertaken in northern Jordan to examine the epidemiological characteristics of echinococcosis in a Muslim community. Forty-four indigenous Jordanians who had been treated for CE between 1990 and 1996 were contacted and three controls for each case, matched for sex and age, were selected from the Jordanian population. The most important single factor associated with treatment for CE was the main source of domestic water; 42 (95%) of the cases but only 81 (61%) of the controls reported that they used a public, piped, water supply as their principal source of household water [odds ratio (OR) = 13.22; 95% confidence interval (CI) = 2.91-83.7]. The keeping of dogs or close association with dogs or farm animals was not associated with any increased risk of CE. However, individuals who grew their own vegetables had a significantly decreased risk of acquiring CE (OR = 0.30; CI = 0.08-0.98). There was evidence of widespread ignorance of the disease and how it is transmitted.

Paraneoplastic bullous stomatitis in a horse.

An adult horse with a 2-month history of anorexia, ataxia, and oral blisters had developed these clinical signs just prior to the appearance and growth of a cervical mass. Bullous stomatitis was characterized histologically as subepidermal clefting. Clinical signs were unresponsive to treatment with antibiotics or corticosteroids; however, surgical removal of the mass coincided with remission of all signs. Histologic findings of the mass were consistent with hemangiosarcoma. Results of indirect immunofluorescence and immunoprecipitation on frozen serum from the horse were characteristic of paraneoplastic pemphigus in human beings, a newly recognized mucocutaneous autoimmune disease associated with neoplasia.