Risk factors for chemotherapy-induced neutropenia occurrence in breast cancer patients: data from the INC-EU Prospective Observational European Neutropenia Study

BACKGROUND: Chemotherapy-induced neutropenia (CIN) places patients at risk of life-threatening infections. While reduction of chemotherapy dose or delay of the subsequent treatment cycle and, consequently, reduction of relative dose intensity (RDI) may limit myelotoxicity, these actions can also impact adversely on treatment outcome and should be avoided in adjuvant settings. PATIENTS AND METHODS: Based on data from 444 breast cancer patients in the INC-EU Prospective Observational European Neutropenia Study, we have evaluated patient-specific and treatment-specific factors that impact on the incidence of grade 4 CIN (absolute neutrophil count <0.5 x 10(9)/L), either during the first or in any cycle of (neo)adjuvant chemotherapy, across a range of regimens and doses. RESULTS: Using multivariate logistic regression analysis, risk factors for grade 4 CIN were identified as older age, lower weight, higher planned dose intensity of doxorubicin, epirubicin, or docetaxel, higher number of planned cycles, vascular comorbidity, lower baseline white blood cell count, and higher baseline bilirubin. Use of colony-stimulating factor before a neutropenic event occurred, dose delays, and dose reductions were protective against grade 4 CIN. CONCLUSIONS: By identifying risk factors for grade 4 CIN, CSF prophylaxis may be appropriately targeted to prevent low RDI in patients treated with curative intent

Effect of culture temperature on fatty acid composition of diatom Cylindrotheca closterium

Fish oil is widely used as a source of essential long chain poly-unsaturated omega-3 fatty acids, such eicosapentaenoic (EPA) and docosahexaenoic (DHA), for aquaculture. However, there is increasing interest in reducing the aquaculture industry?s dependence on this resource due to its unsustainability and variable cost and supply. Marine microalgae naturally produce EPA and DHA fatty acids and they content can be modified by manipulation of the growth conditions. The aim of this study was to assess the effect of temperature on fatty acid composition of the marine diatom Cylindrotheca closterium. To that end, C. closterium was grown in a photobioreactor: a) at 20 °C (control) and b) lowering the temperature from 20°C to 11°C in the stationary growth phase. Total lipid content and lipid fractions were determined spectrophotometrically and gravimetrically. Gas chromatography was performed to analyze fatty acid composition. C. closterium growth was not affected by temperature variation, as showed by cell density and dry weight determinations. When the temperature was lowered, triacylglyceride content significantly increased compared to the control condition. In addition, among omega-3 fatty acids, DHA and EPA showed a marked increase. Thus, these results evidence the potential of this strain as an alternative and sustainable source for aquaculture purposes.Fil: Almeyda, D.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; ArgentinaFil: Scodelaro Bilbao, Paola Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; ArgentinaFil: Constenla, Diana Teresita. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Planta Piloto de Ingeniería Química. Universidad Nacional del Sur. Planta Piloto de Ingeniería Química; ArgentinaFil: Popovich, Cecilia Angelines. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; ArgentinaFil: Leonardi, Patricia Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; ArgentinaLIV Reunión Anual de la Sociedad Argentina de Investigación en Bioquímica y Biología MolecularParanáArgentinaSociedad Argentina de Investigación Bioquímica y Biología Molecula

Economic Impact of a Rotavirus Vaccine in Brazil

The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio

Potential cost effectiveness of a rotavirus vaccine in Chile

Background: Cost effectiveness studies are essential to assess the real value of interventions with preventive or therapeutic objectives. Aim: To assess the theoretical costeffectiveness of a vaccine against rotavirus in Chilean children of less than five years of age. Material and methods: An economic model was developed based on information on disease incidence, health care costs associated with treatment and the effectiveness and costs of vaccination. Net disease and vaccination costs were estimated from the health system perspective and were compared with life years and disability-adjusted life-years (DALYs) gained using a 3% discount rate. Local administrative and accounting hospital data and vaccine efficacy data were used to estimate healthcare costs and cost-effectiveness of vaccination. Results: A rotavirus vaccination program would prevent 10 deaths due to rotavirus gastroenteritis, 6,245 related hospitalizations and 41,962 outpatient visits during the first five years of life, per vaccinated cohort. For every 1,000 children born, the healthcare service spends US$15,077 on treatment of gastroenteritis. From the healthcare perspective, vaccination would yield a cost-effectiveness ratio of US$11,261 per DALY when the price of the vaccine is US$24 per course. Conclusions: Rotavirus vaccine can effectively reduce the disease burden and healthcare costs of rotavirus gastroenteritis and can be a cost-effective investment compared to other options.Patrocinio de GlaxoSmithKline Biologicals

Features of dengue and chikungunya infections of colombian children under 24 months of age admitted to the emergency department

We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue for 19 months (1 January 2013 to 17 August 2014). Prospective data for chikungunya confirmed by real-time polymerase chain reaction were collected for 4 months (22 September 2014-14 December 2014). Sensitivity and specificity [with 95% confidence interval (CI)] were reported for each disease diagnosis. A platelet count <150 000 cells/ml at emergency admission best characterized dengue, with a sensitivity of 67% (95% CI, 53-79) and specificity of 95% (95% CI, 82-99). The algorithm developed with classification and regression tree analysis showed a sensitivity of 93% (95% CI, 68-100) and specificity of 38% (95% CI, 9-76) to diagnose dengue. Our study provides potential differential characteristics between chikungunya and dengue in young children, especially low platelet counts. © The Author [2017].Universidad Nacional de Colombia, UN Johns Hopkins University1Departamento de Epidemiologia, Hospital Infantil Napoleón Franco Pareja—La Casa del Niño, Cartagena, Colombia 2Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia 3Departamento de Epidemiologia, Faculdade de Saúde Publica, Universidade de São Paulo, São Paulo, Brazil 4Facultad de Ingenería, Universidad Tecnológica de Bolívar, Cartagena, Colombia 5Facultad Ciencias Básicas y Biomédicas, Universidad Simón Bolívar, Barranquilla, Colombia 6Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia 7Instituto de Investigaciones Biologicas del Tropico, Universidad de Córdoba, Montería, Colombia 8Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Correspondence: Angel Paternina-Caicedo, Hospital Infantil Napoleón Franco Pareja—La Casa del Niño, Bruselas Transversal 36 N. 36-33, Cartagena, Bolívar, Colombia. Tel: +1-412-3267809. E-mail or

The economic burden of diarrhea in children under 5 years in Bangladesh

Statement on data sources: Datasets, program files and codebooks are available on open access at: Ahmed, Sayem; de Broucker, Gatien; Hasan, Md Zahid; Mehdi, Gazi Golam; Martin del Campo, Jorge; Constenla, Dagna; Patenaude, Bryan; Uddin, Md Jasim, 2020, Cost of diarrhea in children under 5 in Bangladesh (2017–18), https://doi.org/10.7910/DVN/YKPSJ7, Harvard Dataverse, V1, UNF:6:INUNQAM/iu8oOW2iwE/Lnw== [fileUNF] .Supplementary data are available online at: https://www.sciencedirect.com/science/article/pii/S1201971221003490#sec0110 .Background: Diarrhea is a leading cause of morbidity and mortality among under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden on households and health systems. The aim of this study was to estimate the cost of illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh. Method: A cross-sectional study with an ingredient-based costing approach was conducted in 48 healthcare facilities in Bangladesh. In total, 899 caregivers of under-five children with diarrhea were interviewed face-to-face between August 2017 and May 2018, followed up over phone after 7–14 days of discharge, to capture all expenses and time costs related to the entire episode of diarrhea. Results: The average cost per episode for caregivers was US$62, with$29 direct and $34 indirect costs. From the societal perspective, average cost per episode of diarrhea was$71. In 2018, an estimated $79 million of economic costs were incurred for treating diarrhea in Bangladesh. Using 10% of income as threshold, over 46% of interviewed households faced catastrophic expenditure from diarrheal disease. Conclusion: The economic costs incurred by caregivers for treating per-episode of diarrhea was around 4% of the annual national gross domestic product per-capita. Investment in vaccination can help to reduce the prevalence of diarrheal diseases and avert this public health burden.This study was part of the Decade of Vaccine Economics (DOVE) project, funded under a multi-project grant (OPP112821) by the Bill and Melinda Gates Foundation

The economic burden of measles in children under five in Bangladesh

Availability of data and materials: The datasets supporting the conclusions of this article are available in the Harvard Data Verse repository: Ahmed, Sayem; de Broucker, Gatien; Hasan, Md. Zahid; Mehdi, Gazi Golam; Martin del Campo, Jorge; Constenla, Dagna; Patenaude, Bryan; Uddin, Md. Jasim, 2020, “Cost of measles in children under 5 in Bangladesh (2017-18)”, https://doi.org/10.7910/DVN/ZXZEUY, Harvard Dataverse, V2, UNF:6:gGKfNTwvPYwBxaK9xYHtdw== [fileUNF].Supplementary Information is available online at: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05880-5#Sec15 .Background: This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. Method: We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their estimates supported by administrative data from the healthcare perspective. We conducted 100 face-to-face caregiver interviews at discharge and phone interviews 7 to 14 days post-discharge to capture all expenses, including time costs related to measles. All costs are in 2018 USD ($). Results: From a societal perspective, a hospitalized and ambulatory case of measles cost$159 and $18, respectively. On average, the government spent$22 per hospitalized case of measles. At the same time, caregivers incurred $131 and$182 in economic costs, including $48 and$83 in out-of-pocket expenses in public and private not-for-profit facilities, respectively. Seventy-eight percent of the poorest caregivers faced catastrophic health expenditures compared to 21% of the richest. In 2018, 2263 cases of measles were confirmed, totaling $348,073 in economic costs to Bangladeshi society, with$121,842 in out-of-pocket payments for households. Conclusion: The resurgence of measles outbreaks is a substantial cost for society, requiring significant short-term public expenditures, putting households into a precarious financial situation. Improving vaccination coverage in areas where it is deficient (Sylhet division in our study) would likely alleviate most of this burden.This article is part of the Decade of Vaccine Economics (DOVE) project, funded under a multi-project grant (OPP112821) by the Bill & Melinda Gates Foundation, Seattle, WA (USA)

Estimating Costs Associated with a Community Outbreak of Meningococcal Disease in a Colombian Caribbean City

Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$(2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50reported to have meningitis (3/6); 33meningococcaemia and myocarditis (2/6); 50bacteraemia (3/6); 66Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak