Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey:An Illustration Based on Bursa Data

BackgroundWorldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed. Objectives To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey.MethodsA multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter) national literature and publicly available data from the Turkish Statistical Institute (TUIK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained.ResultsVaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US$ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER.ConclusionRSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using relatively conservative assumptions, all evaluated strategies remained slightly below the threshold of 3 times the GDP per capita.</p

Endoscopic Management of Dysphagia in Plummer–Vinson syndrome

Plummer‑Vinson syndrome (PVS), (also called Paterson‑Brown‑Kelly syndrome or sideropenic dysphagia) is an extremely rare syndrome which includes iron-deficiency anemia, dysphagia, and esophageal webs. If left untreated, progressive dysphagia can supervene and the patient is at risk of developing pharyngeal or esophageal squamous-cell carcinoma. Treatment consists of supplementation of iron and endoscopic dilations or surgery for the esophageal web. We describe the case of a 17-year-old women with Plummer- Vinson syndrome whose dysphagia was successfully treated with endoscopic dilation. She remains in good general condition 3 months after treatment

Ultrasound Can Facilitate Percutaneous Endoscopic Gastrostomy Tube Insertion in the Non-Transilluminated Abdominal Wall

Percutaneous endoscopic gastrostomy (PEG), first described in the 1980s, is an enteral nutrition route used for long-term nutrition in patients who cannot be fed by mouth for various reasons but have no gastrointestinal disturbance. It is inserted percutaneously into the stomach with the aid of an endoscope. However, the light of the scope may not be seen in some patients due to certain reasons (obesity, prior operations). In this case, it is not safe to send the needle through the abdominal wall. Ultrasound can facilitate the procedure and also reduce adjacent organ injury

Live Cell Imaging of Bone Marrow Stromal Cells on Nano-pitted and Polished Titanium Surfaces: A Micro-Incubator in vitro Approach

Current orthopedic implants are not conducive for optimal integration of the biomaterial with newly-formed tissue (osseointegration) inside a patient’s body. In this study, medical-rade Ti-6Al-4V was used as a substrate due to its biocompatibility and ability to facilitate cellular adhesion and proliferation. Live cell imaging was conducted on bone marrow stromal cells, genetically modified to express the green fluorescent protein (GFP), from the 24-96 hours growth period, with the first 24 hours of growth being held inside a lab-scale incubator. Periodic images were recorded on nanopitted anodized and polished Ti-6Al-4V substrates to study how substratestiffness influences adhesion and proliferation. Collected images were analyzed for mitosis, adhesion, and filopodia-stretchability using ImageJ, an image processing program. Images were enhanced in order to perform cell counts at 24, 48, 72, and 96 hours of growth. Continuous recordings were produced to account for the number of mitosis occurrences and cellular migration on each of the substrates. Based on the conducted experiments, it appears that polished Ti-6Al-4V has a higher cell adherence than “nanopitted” anodized surface and an improved rate of proliferation which may be because the cells once adhered on the nano-pitted surface have less ability to detach in-order to undergo mitosis.https://engagedscholarship.csuohio.edu/u_poster_2014/1004/thumbnail.jp

A Prospective Study of Etiology of Childhood Acute Bacterial Meningitis, Turkey

Vaccines to prevent bacterial meningitis in this region must provide reliable protection against serogroup W-135

Omani-type spondyloepiphyseal dysplasia with cardiac involvement caused by a missense mutation in CHST3

Tuysuz B, Mizumoto S, Sugahara K, Celebi A, Mundlos S, Turkmen S. Omani-type spondyloepiphyseal dysplasia with cardiac involvement caused by a missense mutation in CHST3.Clin Genet 2009: 75: 375-383. (C) Blackwell Munksgaard, 200

Stenotrophomonas maltophilia Outbreak in Neonatal Intensive Care Unit and Outbreak Management

Objective: Stenotrophomonas maltophilia is a pathogen, which may cause serious outbreak, particularly in neonatal intensive care units, with increasing importance at present. The aim of this study was to assess the epidemiological and clinical features of S. maltophilia epidemic that we encountered in our neonatal intensive care unit and outbreak management

Investigation of methicillin resistant Staphylococcus aureus in neonatal intensive care unit

Methicillin resistant Staphylococcus aureus (MRSA) strains lead to severe infections in immunosupressive patients, geriatric population and premature infants. 27 MRSA strains isolated in the Neonatal Intensive Care Unit was considered as an outbreak and it was aimed to investigate the genetic and epidemiologic relation of the MRSA outbreak. MecA gene was investigated in the S. aureus strains and pulsed field gel electrophoresis (PFGE) was used to investigate the genetic relation between outbreak strains. MecA gene was showed in all isolates. PFGE revealed that there were two different strains and most of the isolates (25/27) were owing to same clone. One of the samples were found closely related with the common strain and the other sample was found genetically unrelated. To terminate the outbreak; liquid baby food was gained to the baby food kitchen, no more new patient was imported to the neonatal unit and none of the patients were exported from neonatal unit to other clinics during outbreak, education about infection control precautions was given to all the staff and nursing bottle dishwasher was obtained. To manage and terminate the outbreak, besides the infection control precautions, tests to determine the genetic relation between outbreak strains which are done in the microbiology laboratory are needed. Molecular analysis of outbreak strains will contribute to prove the epidemiologic and evolution of outbreaks