ABSTRACT
Objective: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. Methods: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. Results: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. Conclusions: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost
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Subject(s)
Humans , Male , Female , Child , Asthma/epidemiology , Adrenal Cortex Hormones/therapeutic use , Cost of Illness , Asthma/economics , Chile/epidemiology , Cohort Studies , Disease Progression , Emergency Medical Services , Follow-Up Studies , Hospitalization , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children
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Subject(s)
Humans , Asthma/epidemiology , Hospitalization/statistics & numerical data , Patient Education as Topic , Observational Study , Adrenal Cortex Hormones/therapeutic use , Asthma/therapy , Caregivers , Disease Progression , Education, Medical, Continuing , Prospective Studies , Patient ComplianceABSTRACT
El EPF es una proteína con propiedades inmunomoduladoras y reguladoras del crecimiento, presente en el suero de los animales durante la gestación. Es un marcador temprano de viabilidad embrionaria durante la fase peri-implantacional. La obtención de anticuerpos(Acs) anti-EPF nos permitiría contar con una valiosa herramienta para investigar las funciones biológicas de este factor. No se ha logrado obtener Acs monoclonales anti-EPF debido a su función como factor de crecimiento autócrino para los hibridomas. La distancia filogenéticaque existe entre las aves y los mamíferos resulta potencialmente ventajosa para la producción de un alto porcentaje de Acs específicos contra antígenos mamíferos. El objetivo de este trabajo fue laobtención de Acs policlonales anti-EPF porcino aviarios y de mamífero, comparando la producción y la especificidad de cada lote de anticuerpos. Se inmunizaron gallinas y conejos con un péptido sintéticode EPF o con la banda de 29 kDa aislada por SDS-PAGE proveniente de suero de una cerda de 7 días de gestación. Las IgY aviarias anti-EPF se purificaron por el método de precipitación con ácido caprílico y polietilenglicol 6000, y las IgG anti-EPF de conejo por precipitación salina con sulfato de amonio. El rendimiento proteico fue evaluado por Bradford y la especificidad de los Acs por Dot Blot eInmunoblot. El rendimiento proteico fue satisfactorio en todos los lotes de Acs. El lote de Acs obtenidos en conejos inmunizados con el péptido sintético presentó especificidad satisfactoria. Los lotes obtenidosen conejos y gallinas inmunizadas con la banda de SDS-PAGE de 29 kDa presentaron baja especificidad, mientras que el lote obtenido en gallinas inmunizadas con el péptido sintético presentó nula especificidad. El péptido sintético de EPF indujo la producción deAcs más específicos en conejos, pero la banda de 29 kDa de SDS-PAGE no es adecuada para obtener Acs específicos contra este factor dado que además del EPF reconoce otras proteínas presentes en el suero
Early Pregnancy Factor (EPF) is a secreted protein with known functions as immunomodulator and growth factor, released very early in mammalian gestation. EPF represents an early marker of gestationand a very useful tool to supervise embryonic viability during the peri-implantational period. Obtaining anti-EPF antibodies (Abs) would mean having a valuable tool to investigate the biological functions ofthis factor, but it has failed so far due to EPF´s function as an autocrine growth factor for hibridomas. The phylogenetic distance between birds and mammals is potentially advantageous for the efficientproduction of specific Abs against mammalian antigens. Thus, the objective of this work was to obtain avian and mammalian polyclonal anti-porcine EPF Abs and to evaluate the protein yield and the specificity of each batch of antibodies. Hens and rabbits were immunizedwith a synthetic EPF peptide, or with EPF isolated and purified from porcine serum of 7 days of gestation by SDS-PAGE (29 kDa band). IgY anti-EPF antibodies from hens were purified by combined caprylic acid and polyethylene glycol 6000 precipitation, and rabbitanti-EPF IgG by sulphate ammonium precipitation. Protein yield was evaluated by Bradford, and Ab specificity by Dot Blot and Immunoblot. The protein yield was satisfactory in all batches of Abs. The specificity of Abs obtained from rabbits immunized with the syntheticEPF peptide was satisfactory. Batches of immunoglobulins obtained from rabbits and hens immunized with the SDS-PAGE 29 kDa band displayed low specificity, whereas the batch obtained from hens immunized with the synthetic peptide presented null specificity. The synthetic peptide induced the production of more specific Abs whenthey were raised in rabbits. In contrast, the SDS-PAGE 29 kDa band is not useful to obtain specific Abs against this factor, since in addition to EPF it recognizes other proteins present in the serum
Subject(s)
Animals , Antibody Specificity , Pregnancy, Animal/immunology , Immunologic Factors/analysis , Swine/immunology , Antibody Formation/immunologyABSTRACT
El potencial rédox (Eh) es una propiedad fisicoquímica que presentan los solutos capaces de intercambiar electrones con un electrodo inerte. El potencial rédox influye en el crecimiento bacteriano en forma independiente del oxígeno disuelto. Es escasa la información disponible en relación a cultivos in vitro de protozoarios, en particular de Trypanosoma cruzi. Para determinar el efecto del Eh sobre los parámetros de cultivos, se empleó la cepa Tulahuén 0, desarrollada en medio CIEN líquido en agitación y se ensayaron valores de Eh entre 310 mV (testigo) y 110 mV en 11 réplicas diferentes y duplicadas. Se determinaron pH, velocidad específica de desarrollo (µ), Eh, rH, velocidad de consumo de glucosa y rendimiento. Los resultados muestran que µ varía en forma directa con el Eh. Se establece una alta correlación (r = 0,93; P < 0,01) entre rH [rH = (Eh(V)+ 0,06 pH)/0,03] y µ, manteniendo constante la concentración de oxígeno disuelto. Los otros parámetros del medio no mostraron variaciones significativas. Se concluye que variaciones en el Eh del medio de cultivo afectan en forma significativa la µ del T. cruzi y que es una variable a tener en cuenta cuando se ensayan sustancias con probable efectos tripanocidas.
The redox potential (Eh) is a physico-chemical property presented by solutes able to interchange electrons with an inert electrode. The redox potential influences bacterial growth in an independent way from dissolved oxygen. The available information about protozoaries in vitro grown is scarce, being Trypanosoma cruzi main example. T. cruzi Tulahuén 0 strain, developed in CIEN liquid stirred media, was used to determine the Eh effect on growth parameters. Eh values between 310 mV (reference) and 110 mV were measured in 11 different samples and by duplicate. pH, m, Eh, rH, consume glucose rate and efficiency were determined. Results show that specific rate of development (µ) varies in a direct way with Eh. A high correlation (r = 0.93; P < 0.01) between rH (rH = Eh(V)+ 0.06 pH) and µ was established, even when dissolved oxygen concentration remained constant. Other parameters in the growing medium showed no significant variations. It is concluded that changes on Eh in the medium significantly affect of T. cruzi's growth being a variable to take into account when potential trypanocide substances are analyzed.