A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.

BACKGROUND: Antibiotic prescription for respiratory tract infections (RTIs) in children attending primary care centres is almost double that predicted according to bacterial prevalence. Delayed antibiotic prescription (DAP) is designed to deploy a more rational use of antibiotics. While studies have evaluated DAP efficacy and safety for children with RTIs, little research has been conducted on the economic implications. METHODS: Our trial compared cost-effectiveness for DAP, immediate antibiotic prescription (IAP), and no antibiotic prescription (NAP) for children aged 2-14 years with acute uncomplicated RTIs attended to in 39 primary care centres in Spain. The main outcome was the incremental cost-effectiveness ratio (ICER), measured in euros per gained quality-adjusted life days (QALDs). Net monetary benefit (NMB) was also calculated as a tool for decision making. The analysis was performed from a societal perspective for a time horizon of 30 days, and included healthcare direct costs, non-healthcare direct and indirect costs, and the antimicrobial resistance (AMR) cost. RESULTS: DAP was the most cost-effective strategy, even when the cost of AMR was included. QALD values for the three strategies were very similar. IAP compared to DAP was more costly (109.68 vs 100.90 euros) and similarly effective (27.88 vs 27.94 QALDs). DAP compared to NAP was more costly (100.90 vs 97.48 euros) and more effective (27.94 vs. 27.82 QALDs). The ICER for DAP compared to NAP was 28.84 euros per QALD. The deterministic sensitivity analysis indicated that non-healthcare indirect costs had the greatest impact on the ICER. The cost-effectiveness acceptability curve showed that DAP was the preferred option in approximately 81.75% of Monte Carlo iterations, assuming a willingness-to-pay value of 82.2 euros per gained QALD. CONCLUSIONS: When clinicians are in doubt about whether an antibiotic is needed for children with RTIs attending PC centres, those treated with the DAP strategy will have slightly better efficiency outcomes than those treated with IAP because its costs are lower than those of IAP. DAP is also the most cost-effective strategy over a time horizon of 30 days if AMR is considered, despite higher short-term costs than NAP. However, if in the long term the costs of AMR are larger than estimated, NAP could also be an alternative strategy. TRIAL REGISTRATION: This trial has been registered at www. CLINICALTRIALS: gov (identifier NCT01800747; Date: 28/02/2013 (retrospectively registered).

Activity Measurement of 44Sc and Calibration of Activity Measurement Instruments on Production Sites and Clinics.

44Sc is a promising radionuclide for positron emission tomography (PET) in nuclear medicine. As a part of the implementation of a production site for 44Sc, precise knowledge of the activity of the product is necessary. At the Paul Scherrer Institute (PSI) and the University of Bern (UniBE), 44Sc is produced by enriched 44CaO-target irradiation with a cyclotron. The two sites use different techniques for activity measurement, namely a dose calibrator at the PSI and a gamma-ray spectrometry system at UniBE and PSI. In this work, the 44Sc was produced at the PSI, and samples of the product were prepared in dedicated containers for onsite measurements at PSI, UniBE, and the Institute of Radiation Physics (IRA) in Lausanne for precise activity measurement using primary techniques and for the calibration of the reference ionization chambers. An accuracy of 1% was obtained for the activity measurement, allowing for a precise calibration of the dose calibrator and gamma-ray spectrometry of the two production sites. Each production site now has the capability of measuring 44Sc activity with an accuracy of 2%.

Synthesis of a Zinc Hydroxystannate/Sepiolite Hybrid Additive to Avoid Fire Propagation and Reduce Smoke Emission of EPDM Rubber Nanocomposites.

A zinc hydroxystannate/sepiolite (SEPZHS) hybrid additive was successfully prepared following a facile wet chemical route synthesis where zinc hydroxystannate (ZHS) nanoparticles were grown on the sepiolite's surface. SEPZHS particles have a fibrillar structure with ZHS nanoparticles homogeneously dispersed and with significantly smaller particle sizes than the synthesized ZHS nanoparticles alone. Sepiolite and SEPZHS were organically modified and introduced in a basic ethylene propylene diene monomer rubber (EPDM) formulation for cable to evaluate the nanocomposite behavior under direct fire sources. The results confirmed the synergistic effect of the hybrid SEPZHS additive in the formation of a most stable and efficient char barrier, thus improving the flame-retardant behavior of EPDM nanocomposite in terms of heat emission, with reductions of more than 40% in the peak of Heat Release Rate (cone calorimeter test), and smoke suppression, with more than 25% reduction in the Total Smoke Production and Smoke Density parameters (smoke chamber test). Moreover, the addition of sepiolite-based additives increased the mechanical properties (hardness) of the nanocomposites, as a result of the matrix reinforcement. This suggests that the SEPZHS hybrid additive may provide a promising option for a new, cost-effective, eco-friendly, yet efficient flame-retardant solution.

Clinical outcomes and safety of Diphoterine® irrigation for chemical eye injury: A single-centre experience in the United Kingdom.

PURPOSE: Diphoterine® is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury (CEI). However, its use is not widely adopted in current clinical practice, primarily attributed to limited clinical evidence. This study aims to highlight the experience in using Diphoterine for managing CEI in a UK tertiary referral centre. METHODS: This retrospective case series included all patients who presented with CEI and treated with Diphoterine at the James Cook University Hospital, UK, between April 2018 and February 2020. RESULTS: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years (ranged, 3-70 years) and 85.7% were male. All patients presented with an alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median (±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of 0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the eyes were of grade-I and -IV CEI, respectively. All eyes received normal saline/water as the first irrigation fluid and Diphoterine as second irrigation fluid. The mean pH improved slightly after first irrigation (8.4 ± 0.7; p = 0.13) and significantly after second irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation used was significantly less for Diphoterine (520 ± 193 mL) than for normal saline/water (2700 ± 2451 mL; p = 0.016). At final follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28 logMAR (p = 0.60). One patient developed near-total limbal stem cell deficiency as a complication of grade-IV injury and was awaiting limbal stem cell transplantation at last follow-up. CONCLUSION: This study represents the first case series in the United Kingdom, reporting the use of Diphoterine in managing CEI. The rapid pH-neutralising action of Diphoterine, with less volume required, makes it an ideal initial treatment for efficiently managing adult and paediatric patients with CEI in clinics.

Study of visual acuity and contrast sensitivity in diabetic patients with and without non-proliferative diabetic retinopathy.

PURPOSE: To analyze high and low contrast visual acuity and contrast sensitivity in diabetic patients without clinically significant macular edema associated or not with non-proliferative diabetic retinopathy. METHODS: Cross-sectional study of 368 eyes of 368 patients classified into three groups: a) disease-free patients, b) patients with diabetes mellitus (DM) without diabetic retinopathy, c) DM patients with non-proliferative diabetic retinopathy. All patients underwent a complete ophthalmological examination that included high and low contrast visual acuity with 1.25%, 2.5% and 5% contrast chart and Pelli-Robson type contrast sensitivity test. RESULTS: We observed no statistically significant differences regarding age, intraocular pressure, duration of diabetes or high contrast visual acuity. The eyes of patients with non-proliferative diabetic retinopathy had worse contrast sensitivity (p = 0.03, in both cases) and low contrast visual acuity at 1.5% (p = 0.03 and p = 0.01), 2.5% (p = 0.01, in both cases) and 5% (p = 0.02 and p = 0.04) than patients free of disease or without diabetic retinopathy. CONCLUSIONS: Analysis of contrast sensitivity and low contrast visual acuity could be considered as markers of visual function impairment in the eyes of patients with non-proliferative diabetic retinopathy.

Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial.

OBJECTIVES: To assess the effectiveness and safety of delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) in children with uncomplicated respiratory infections. METHODS: Randomized clinical trial comparing 3 antibiotic prescription strategies. The participants were children with acute uncomplicated respiratory infections attended to in 39 primary care centers. Children were randomly assigned into prescription arms as follows: (1) DAP, (2) IAP, or (3) NAP. Primary outcomes were symptom duration and severity. Secondary outcomes were antibiotic use, parental satisfaction, parental beliefs, additional primary care visits, and complications at 30 days. RESULTS: In total, 436 children were included in the analysis. The mean (SD) duration of severe symptoms was 10.1 (6.3) for IAP, 10.9 (8.5) for NAP, and 12.4 (8.4) for DAP (P = .539), although the differences were not statistically significant. The median (interquartile range) of the greatest severity for any symptom was similar for the 3 arms (median [interquartile range] score of 3 [2-4]; P = .619). Antibiotic use was significantly higher for IAP (n = 142 [96%]) compared to DAP (n = 37 [25.3%]) and NAP (n = 17 [12.0%]) (P < .001). Complications, additional visits to primary care, and satisfaction were similar for all strategies. Gastrointestinal adverse effects were higher for IAP. CONCLUSIONS: There was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received DAP compared to NAP or IAP strategies; however, DAP reduced antibiotic use and gastrointestinal adverse effects.

Environmental impact of nano-functionalized construction materials: leaching of titanium and nitrates from photocatalytic pavements under outdoor conditions.

There is a growing use of nano-functionalized construction materials, which contain nanoparticles embedded in their bulk or deposited on their surfaces. In the case of photocatalytic materials, nano-TiO2 is usually added to provide it's functionality. One concern about these materials, in addition to release of nanoparticles as airborne, is that they can be leached into the aquatic environment. Moreover, water eutrophication could be caused due to the increase in NO3- as a product of the photocatalytic oxidation of NOx in runoff. In this paper, a systematic long term campaign assessing these potential side effects in the real outdoor environment has been carried out. Rainwater leachates from 4 m2 slabs of 7 different photocatalytic materials exposed outdoors in two different locations (platforms) were collected and analysed over more than 800 days. Ti, NO3-, pH and conductivity were analysed. Ti was found in the leachates of almost every material, without a clear relation with the type of application (percolated cementitious slurry, suspension/emulsion or TiO2 built-in). The highest concentration found was of 60 µg/L, which seems to be rather small when comparing with some threshold values for drinking water. In all the cases, the detected TiO2 nanoparticles from water leachates were embedded in large microparticle agglomerates coming from the construction material matrix, which are less dangerous than nanoparticles. Nitrates were leached in clear relation with the NOx oxidation photocatalytic performance, and the observed concentrations were not higher than those in the recycled water used by the Madrid City Council to clean the streets.

Influencia de las formas de organización en la asistencia a la población infantil en España / Influence of the forms of organization in the assistance to the infantile population in Spain

La forma de la organización sanitaria puede influir en la asistencia a la población infantil. La Asociación Española de Pediatría de Atención Primaria realiza un análisis de diferentes formas de atención asistencial: pediatra de área, modelos mixtos público-privados, organizaciones interniveles y participación de los pediatras de Atención Primaria en las guardias hospitalarias y aporta posibles actuaciones de mejora en cada uno de ellos

The way in which health care is organized can influence the assistance to children. The Spanish Association of Pediatrics of Primary Care (AEPap) performs an analysis of different forms of care: area pediatrician, mixed public-private models, inter-level organizations and participation of primary care pediatricians as doctors on duty at the hospital, and provides possible improvement actions in each one of them

A portable precision ionization chamber: The transfer ionization reference chamber.

A portable instrument was developed at the Institute of Radiation Physics (IRA) for on-site radionuclides measurements. It will enable the measurement of short-lived radionuclides in nuclear medicine departments or isotope production centres. The system involves an ionization chamber read directly by an electrometer and it was optimized to ensure a good reproducibility through the selection of an appropriate vial, filling volume and source position in the well chamber, as well as monitoring the external background and performing a detailed uncertainty estimation. The calibration factors were determined using solutions whose activity concentration is traceable to the international reference system using the IRA reference chamber. Currently the transfer ionization chamber is calibrated for F-18, C-11, O-15, N-13, I-131 and Tc-99m. The final instrument is able to measure isotope activities with a relative standard uncertainty not larger than 1%.

On the influence of the vacancy distribution on the structure and ionic conductivity of A-site-deficient Li(x)Sr(x)La(2/3-x)TiO3 perovskites.

The crystal structure and dielectric properties of slowly cooled A-site-deficient perovskites Li(x)Sr(x)La(2/3-x)□(1/3-x)TiO(3) (0.04 ≤ x ≤ 0.33) have been investigated by powder X-ray diffraction (XRD), impedance spectroscopy, and (7)Li NMR techniques. In this series, nominal vacancies decrease with Li content, but the total amount of A-site vacancies, n(t) = Li + □, participating in conduction processes remains basically constant. Rietveld analysis of the XRD patterns showed a change of symmetry from orthorhombic to tetragonal when the lithium and strontium contents increased above x = 0.08 and from tetragonal to cubic above x = 0.16. Structural modifications are mainly due to the cation vacancy ordering along the c axis, which disappear gradually when the lithium content increases. In agreement with the structural information, two lithium signals with different quadrupole constants are detected in (7)Li NMR spectra of orthorhombic/tetragonal phases, which have been associated with lithium in two crystallographic z/c = 0 and 1/2 planes of perovskites. In cubic samples, only a single narrow component, indicative of mobile species, was detected. Lithium motion was thermally activated, with activation energies going from 0.35 to 0.38 eV. Evolution of the bulk dc-conductivity preexponential factors along the series showed a maximum that has been first related to the dependence of lithium hopping on the lithium and vacancy concentrations. Finally, changes in the vacancy ordering, produced along the series, affect the dimensionality of the conductivity, indicating that not only the amount of vacancies but also its distribution are relevant.

Adjunctive treatment with risperidone in clozapine-resistant schizophrenia: a case report and review.

OBJECTIVES: Long-term studies show that 47% to 63% of schizophrenic patients treated with clozapine fail to respond after 12 years of treatment. Such high rates of resistance justify the growing interest in therapeutic strategies based on enhancing the effect of clozapine with other antipsychotics. The combination of clozapine and risperidone in the treatment of partial responders to clozapine has been one of those receiving most interest from research. METHODS AND RESULTS: The present work reports the case of a 26-year-old man, diagnosed with schizophrenia who, after treatment with clozapine at appropriate doses over 12 weeks without observable response, showed a marked and sustained improvement after the addition of risperidone to the clozapine treatment. We also present a detailed review of publications related to the therapeutic combination of clozapine and risperidone in clozapine-resistant schizophrenia. CONCLUSIONS: Despite the contradictory nature of the published data, our results are in support of other work reporting that treatment with a combination of clozapine and risperidone, apart from being well tolerated, may constitute an effective alternative in this type of patient. Nevertheless, there is a need for further, controlled studies, with larger samples, with a view to drawing definitive conclusions and making specific recommendations.

Fibrosis quística, bocio e hipertiroidismo / Cystic fibrosis, goiter and hyperthyroidism

El aumento de tamaño de la glándula tiroidea por depósito de material amiloide, conocido como bocio amiloide, es una rara entidad clínica. En la mayoría de los casos publicados, los pacientes presentan una función tiroidea normal; menos frecuente es la presencia de hipofunción tiroidea, y aún más infrecuente la asociación con hiperfunción tiroidea. Comunicamos un caso de bocio amiloide e hipertiroidismo primario, secundario a amiloidosis sistémica, en un paciente con fibrosis quística, sin síntomas compresivos y clínica de hiperfunción tiroidea. A continuación, realizamos una breve revisión de este proceso y su tratamiento (AU)

Thyroid gland enlargement due to amyloid infiltration, known as amyloid goitre, is a rare clinic entity. In most reported cases, patients' thyroid function is normal; less frequent is the presentation with thyroid hypofunction, and exceedingly rare is its association with thyroid hyperfunction. We hereby report a case of amyloid goitre and primary hyperthyroidism, due to systemic amyloidosis, in a patient with cystic fibrosis, without compressive symptoms. Then, we provide a brief review of this entity and its therapeutic management (AU)

Psychopathology in the Lujan-Fryns syndrome: report of two patients and review.

We report on two new patients, the propositus and his maternal uncle, with Lujan-Fryns syndrome (LFS). One presented with mild mental retardation and both patient had Marfanoid habitus and similar craniofacial anomalies (they had a long and narrow face, small mandible, high-arched palate, and hypernasal voice) as previously reported by Lujan et al. in 1984 and Fryns and Buttiens in 1987. One of our patients had agenesis of the corpus callosum as described by Lujan. The second patient had an ascending aortic aneurysm like the patient described by Wittine et al. 1999. Both patients showed similar behavior and psychiatric disorders. In addition, we reviewed the literature for the presence of psychopathology in LFS. After studying the 32 published cases and the 2 described in this article, we found that more than 90% of the patients present with some type of psychopathology, the most frequent being an autistic-like disorder. In our opinion, the agenesis of the corpus callosum (complete or partial) and ascending aorta aneurysm are manifestations of LFS, and thus brain MRI and echocardiogram should be part of the routine evaluation. Additionally, the high prevalence of psychopathological alterations in these patients suggests the need for psychiatric evaluation at the time of diagnosis.

Rosetoid schwannoma (neuroblastoma-like) in association with an anetoderma.

BACKGROUND: We report an additional case of an extremely uncommon but distinctive histological variant of benign schwannoma, which was previously designated as neuroblastoma-like schwannoma by Goldblum et al. METHODS: A 29-year-old woman referred to a 6-year-history of an atrofic macule. Its clinical appearance was similar to that of an anetoderma. RESULTS: A cutaneous biopsy showed findings consistent with a neuroblastoma-like schwannoma with the following peculiar features: (i) Being fully composed of rosette-like structures. (ii) Association to an anetoderma. CONCLUSIONS: Because neither the histological pattern nor the type of tumor allows a differential diagnosis with neuroblastoma, we propose the descriptive term of rosetoid schwannoma. And to our knowledge, this will be the first case reported of rosetoid schwannoma associated to anetoderma.