Cost-effectiveness in Clostridium difficile treatment decision-making

AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection(CDI).METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines.RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.

Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium;collected 33 isolates during three years from 2017 to 2020;used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group;while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%;finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone;especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance;for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance;in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance;in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.

Spatial variation of carbon dioxide fluxes in corn and soybean fields

Spatial variation of soil carbon dioxide (CO2) flux during a growing season within corn and soybean canopies has not been quantified. These cropping systems are the most intense in the United States and the potential for carbon (C) sequestration in these systems through changes in soil management practices create an opportunity for reduction in greenhouse gas emissions;however, the need to understand the variation in fields is critical to evaluating changes in management systems. A study was designed to evaluate the spatial variation in soil CO2 fluxes along two transects in corn and soybean fields. Samples were collected every 5 m along a 100 m transect between the rows of the crop and also along a transect in which the plants had been removed to reduce the potential of root respiration. Soil CO2 fluxes were collected at each position with air temperature, soil temperature at 0.05 m, and soil water content (0 - 0.06 m). At the end of the season, soil samples for the upper 0.1 m were collected for soil organic C content, pH, sand, silt, and clay contents. On each day measurements were made, the observed CO2 emissions were scaled by dividing the CO2 flux at each position by the mean CO2 flux of the entire transect. Observed CO2 fluxes were signifycantly larger in the row than in the fallow position for both crops. There were no differences between the corn and soybean fallow transects;however, the corn row samples were larger than the soybean row samples. No consistent spatial patterns were observed in the CO2 fluxes or any of the soil properties over the course of the study. When the CO2 flux data were combined over the season, there was a significant spatial pattern in the fallow transects for both crops but not for the row transects. Sampling for CO2 flux values in cropping systems has to consider the presence of a crop canopy and the amount of root respiration.

Paraben Content in Adjacent Normal-malignant Breast Tissues from Women with Breast Cancer

Objective Accumulation of estrogenic compounds and other carcinogens in normal breast tissues contributes to unpredictable breast cancer incidence during adolescence and throughout life.To assess the role of parabens in this phenomenon,the paraben content of adjacent normal-malignant breast tissues is measured in women with breast cancer living in Isfahan Province,Iran.Methods Adjacent normal-malignant breast tissue samples were obtained from 53 subjects.The parabens including methyl-paraben(Me PB),ethyl-paraben(Et PB),propyl-paraben(Pr PB),and butylparaben(Bu PB)were extracted from the sample supernatant and then subjected to gas chromatography analysis.Results Some risk factors for breast cancer were stimulated by parabens in adjacent malignant-normal breast tissues among young and middle-aged women with breast cancer.We observed a significant association for dose-response pattern of Me PB[OR=98.34(11.43–185.2),P=0.027]for both ER+and PR+women and Me PB[OR=164.3(CI:112.3–216.3),P<0.001]for HER2+women than women with negative receptors.The risk of 95-fold increase in Me PB dose and 164-fold increase in∑PBs dose were significant for women with hereditary breast cancer in first-degree relatives.Conclusions These results may promote future epidemiology studies and strategies to improve women's lifestyle and consume paraben-free products.

霉菌特异性定量聚合酶链反应(PCR):霉菌分析中的新标准

霉菌在地球生物进程中是一个必需成分,无处不在。它们不仅能危害健康,例如导致感染和过敏,还能毁坏农作物、污染食品和医药品。因此,及时地发现并消灭多数有问题的霉菌是相当重要的。通过霉菌特异性定量聚合酶链反应技术的最新发展及应用,现在可以准确地识别室内的霉菌,并且利用其较高的定量精度,可以建立用于确定不正常霉菌环境的预测模型。

社区获得性肺炎中MRSA的治疗

编辑gHoare和Lim关于社区获得性肺炎的诊治新进展一文中没有提到耐万古霉素（methicillin）的金黄色葡萄球菌属（MRSA）。作为一种在住院患者和出院患者中存在的社区相关性病原体，MRSA已经越来越常见。新近暴露于MRSA的患者常常进展为感染，除非得到彻底清除。一项研究表明，在MRSA首次移生到人体后的18个月内，超过1／4的人会出现进一步的MRSA感染，其中多数为肺炎。