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).

Diabetes gestacional y pregestacional: características perinatales y morbilidad neonatal / Gestational and pregestational diabetes: Perinatal characteristics and neonatal morbidity

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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.

Pathogenic, Morphological, and Phylogenetic Characterization of Fusarium solani f. sp. cucurbitae Isolates From Cucurbits in Almería Province, Spain.

Fusarium solani f. sp. cucurbitae (syn. Neocosmosporum cucurbitae) is one of the most devastating soilborne pathogens affecting the production of cucurbits worldwide. Since its first detection in Almería Province in Spain in the spring of 2007, it has become one of the main soilborne pathogens affecting zucchini production. It has also been reported on melon, watermelon, and squash rootstocks in Spain, representing a high risk of dissemination in the area. The objectives of this study were to investigate the incidence and distribution of this disease in southeastern Spain and characterize isolates collected over 5 years. These strains were characterized on the basis of greenhouse aggressiveness assays on a range of cucurbit hosts, morphological characteristics, and elongation factor 1-α and RNA polymerase II second largest subunit phylogenies. All pathogenic isolates were highly aggressive on zucchini plants, causing a high mortality rate a few weeks after inoculation. The rest of the cucurbit hosts showed differential susceptibility to the pathogen, with cucumber being the least susceptible. Plants belonging to other families remained asymptomatic. Morphological characterization revealed the formation of verticilate monophialides and chlamydospores forming long chains, characteristics not described for this forma specialis. Phylogenetic studies of both the individual loci and combined datasets revealed that all pathogenic isolates clustered together with strong monophyletic support, nested within clade 3 in the F. solani species complex.

Survival of Fusarium solani f. sp. cucurbitae and Fungicide Application, Soil Solarization, and Biosolarization for Control of Crown and Foot Rot of Zucchini Squash.

Fusarium crown and foot rot of zucchini squash (Cucurbita pepo L.) caused by Fusarium solani f. sp. cucurbitae is one of the major diseases affecting zucchini squash production in Almería, Spain. Experiments were conducted to determine the pathogen's ability to survive in infested bags of perlite and to test several control methods under greenhouse conditions. The pathogen survived in the bags for at least 20 months with enough inoculum at that time to produce disease symptoms in zucchini plants, although disease severity was significantly reduced after 14 months. A total of 14 zucchini cultivars were inoculated with F. solani f. sp. cucurbitae, and all were highly susceptible to the disease. Eight fungicides and two microbial products, Trichoderma harzianum and Rhizophagus irregularis, were tested to determine their efficacy for the control of this disease. Prochloraz, carbendazim, and thiophanate-methyl, which are not labeled for use in zucchini in Spain, were highly effective for the control of the disease, while the other products were ineffective. Two soil solarization and biosolarization experiments were conducted in a greenhouse for 45-day periods during the summer. Inocula in the soil samples decreased by more than 99%, indicating the efficacy of completely closing the greenhouse windows, solarization, and biosolarization in reducing inoculum. Fungicide applications, crop rotation for at least two years, and soil solarization or biosolarization are promising control methods for this disease.

Mechanisms linking excess adiposity and carcinogenesis promotion.

Obesity constitutes one of the most important metabolic diseases being associated to insulin resistance development and increased cardiovascular risk. Association between obesity and cancer has also been well established for several tumor types, such as breast cancer in post-menopausal women, colorectal, and prostate cancer. Cancer is the first death cause in developed countries and the second one in developing countries, with high incidence rates around the world. Furthermore, it has been estimated that 15-20% of all cancer deaths may be attributable to obesity. Tumor growth is regulated by interactions between tumor cells and their tissue microenvironment. In this sense, obesity may lead to cancer development through dysfunctional adipose tissue and altered signaling pathways. In this review, three main pathways relating obesity and cancer development are examined: (i) inflammatory changes leading to macrophage polarization and altered adipokine profile; (ii) insulin resistance development; and (iii) adipose tissue hypoxia. Since obesity and cancer present a high prevalence, the association between these conditions is of great public health significance and studies showing mechanisms by which obesity lead to cancer development and progression are needed to improve prevention and management of these diseases.

Activation of noncanonical Wnt signaling through WNT5A in visceral adipose tissue of obese subjects is related to inflammation.

CONTEXT: Wingless-type mouse mammary tumor virus integration site family (WNT)-5A is a glycoprotein involved in the regulation of the inflammatory response by activating the noncanonical Wnt signaling pathway. Secreted frizzled-related protein (SFRP)-5 acts as a decoy receptor that binds and sequesters WNT5A, preventing activation of frizzled receptors and attenuating the noncanonical Wnt signaling. OBJECTIVE: The aim of the study was to evaluate the involvement of WNT5A and SFRP5 in obesity and obesity-related comorbidities as well as to explore their effect in visceral adipose tissue inflammation. PATIENTS AND METHODS: Samples obtained from 90 subjects were used. Circulating and gene expression levels of WNT5A and SFRP5 were analyzed in different metabolic tissues. The effect of TNF-α and lipopolysaccharide on the transcript levels of WNT5A and SFRP5 in adipocytes was explored. We also investigated whether WNT5A itself can activate an inflammatory response. RESULTS: Increased circulating levels of WNT5A in obese patients (P < .05) were decreased (P < .001) after gastric bypass. In this line, WNT5A mRNA in visceral adipose tissue was increased (P < .05) in obese patients with gene expression levels of SFRP5 being down-regulated (P < .05). WNT5A mRNA expression was significantly enhanced (P < .01) by lipopolysaccharide and TNF-α treatment, whereas no effects were found in SFRP5 gene expression levels. Furthermore, exogenous WNT5A induced (P < .05) IL-6, IL1B, MMP2, MMP9, and SSP1 mRNA expression in human adipocyte cultures. CONCLUSIONS: Activation of noncanonical Wnt signaling through the up-regulation of WNT5A and down-regulation of SFRP5 may promote a proinflammatory state in visceral adipose tissue contributing to the development of obesity-associated comorbidities.

Principales taxones de culícidos con interés sanitario detectados en los municipios de Camajuaní y Remedios

Se realizó un estudio descriptivo y retrospectivo con el objetivo decaracterizar la fauna de culícidos de los municipios Camajuaní y Remedios, desde el año 2006 hasta el 2010. Las muestras fueron obtenidas utilizando diferentes métodos establecidos por la OPS y la OMS, tanto para la fase larval como para la adulta (encuesta larvaria:método del cucharón, encuesta adulto: captura de adulto en reposo y cebo humano). Todo esto nos permitió identificar 22 especies de mosquitos, siendo Ochlerotatus serratus, Culex sphinx, Wyeomyia mitchelli y Orthopodomyia signífera los últimos registros para el municipio de Camajuaní y esta última para el de Remedios. Se concluye que el territorio cuenta con una amplia fauna de mosquitos y dentro de ella, una cantidad considerable de especies conpotencialidades para trasmitir enfermedades al hombre y a losanimales(AU)