Costs and cost-effectiveness of tuberculosis cultures using solid and liquid media in a developing country.

SETTING: The expansion of culture has been proposed to aid tuberculosis (TB) control in developing countries. OBJECTIVES: To examine the cost and cost-effectiveness at the Zambian National TB Reference Laboratory of homemade and commercially produced Löwenstein-Jensen culture (HLJ and CLJ) as well as automated and manually read liquid culture (AMGIT and MMGIT). DESIGN: Costs were estimated from the provider's perspective and based on the average monthly throughput. Cost-effectiveness estimates were based on yield during the study period. RESULTS: All techniques show comparable costs per culture (between US$28 and $32). Costs per Mycobacterium tuberculosis specimen detected were respectively US$197, $202, $312 and $340 for MMGIT, AMGIT, CLJ and HLJ. When modelled for the maximum throughput, costs were above US$95 per M. tuberculosis specimen detected for all techniques. When only performed among smear-negative specimens, costs per additionally identified M. tuberculosis would be US$487 for MMGIT and higher for other methods. CONCLUSION: Based on cost-effectiveness grounds, liquid media compare well with conventional solid media, especially where yield of MGIT is substantially higher than that of LJ media. The results indicate high overall costs per culture; the expansion of culture to decentralised levels with lower throughputs may result in even higher costs.

Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of respiratory distress syndrome.

OBJECTIVE: To compare the relative safety and efficacy of Infasurf (calf lung surfactant extract; ONY, Inc, Amherst, NY, IND #27169) versus Survanta (Beractant, Ross Laboratories, Columbus, OH) in reducing the acute severity of respiratory distress syndrome (RDS) when given at birth and to infants with established RDS. DESIGN: A prospective, randomized, double-blind, multicenter clinical trial. SETTING: Thirteen neonatal intensive care units participated in the treatment arm: seven of these concurrently participated in the prevention arm. PATIENTS: The treatment arm enrolled infants of

Impact of lactation on women with cystic fibrosis and their infants: a review of five cases.

OBJECTIVE: To evaluate the impact of lactation on the health status of women with cystic fibrosis and their infants. DESIGN: Data were acquired through a retrospective review of pulmonary, obstetric, and pediatric medical records. SETTING: A medical school-based Pediatric Cystic Fibrosis Center in Philadelphia, Pa. SUBJECTS: Five women with cystic fibrosis and their respective infants. MAIN OUTCOME MEASURES: For the women, measures of pregravid, gravid, and postpartum height, weight, pulmonary function test results, and energy intake were determined. For the infants, birth Apgar scores were obtained, as were measures of growth and development. STATISTICAL ANALYSES PERFORMED: Means and standard deviations were calculated. Data were compared with published standardized references. RESULTS: Mean maternal age at conception was 25.4 +/- 4.1 years. Mean pregravid weight was 60.0 +/- 10.7 kg of standard body weight for height (range = 50.8 to 76.7 kg; median = 58 kg). Two women consumed up to two enteric-coated supplemental enzyme capsules per meal, three women consumed none. Pulmonary disease was mild in four of the five women. Mean weight gain during pregnancy was 10.2 +/- 7.4 kg. Mean gestation was 37.4 +/- 1.5 weeks; mean birth weight was 3.0 +/- 0.5 kg. Sweat tests performed on all infants were negative. Duration of breast-feeding was 3 to 30 weeks. Four of the five infants maintained appropriate growth velocity during breast-feeding. Mean maternal energy intake during lactation was above the Recommended Dietary Allowance for lactating women. Four of the five women were at or above their standard body weight during lactation. CONCLUSIONS/APPLICATIONS: We conclude that women with the clinical diagnosis of mild cystic fibrosis disease can maintain a normal pregnancy with appropriate weight gain and can deliver infants of normal weight for gestational age. During lactation, women with mild cystic fibrosis disease can maintain their own weight and support growth in healthy infants. The dietitian needs to be an integral member of the health care team in assessing, monitoring, and managing women with cystic fibrosis during their child-bearing years.

Epidemiologic considerations of ethylene glycol intoxication in small animals.

Using necropsy records and a practitioner survey, data for certain epidemiologic parameters on EG intoxication in dogs and cats were collected and analyzed. The practices surveyed reported diagnosing 150 cases/year in the 7-county metropolitan area of Minneapolis/St Paul, MN, compared with 32 cases reported in a nationwide survey done a decade earlier. Analysis of necropsy records showed that the annual number of post mortem cases had quintupled over the past decade, with the majority of cases occurring the colder months of the year. Cases involving dogs were twice as common as those involving cats, and males appeared twice as often as females in both species. Young male dogs, under 24 months of age, were the most frequently represented, with female dogs less than 12 months old the next most frequent group.