Antimigraine medication use and associated health care costs in employed patients

Migraine is under diagnosed and suboptimally treated in the majority of patients, and also associated with decreased productivity in employees. The objective of this retrospective study is to assess the antimigraine medication use and associated resource utilization in employed patients. Patients with primary diagnosis of migraine or receiving antimigraine prescription drugs were identified from an employer-sponsored health insurance plan in 2010. Medical utilization and health care costs were determined for the year of 2010. Generalized linear regression was applied to evaluate the association between health care costs and the use of antimigraine medications by controlling covariates. Of 465 patients meeting the study criteria, nearly 30% that had migraine diagnosis were prescribed antimigraine medications, and 20% that had migraine diagnosis were not prescribed antimigraine medications. The remaining 50% were prescribed antimigraine medications but did not have migraine diagnosis. Patients with antimigraine medication prescriptions showed lower frequency of emergency department visits than those without antimigraine medication prescriptions. Regression models indicated an increase in migraine-related health care costs by 86% but decreases in all-cause medical costs and total health care costs by 42 and 26%, respectively, in the antimigraine medication use group after adjusting for covariates. Employed patients experienced inadequate pharmacotherapy for migraine treatment. After controlling for covariates, antimigraine prescription drug use was associated with lower total medical utilization and health care costs. Further studies should investigate patient self-reported care and needs to manage headache and develop effective intervention to improve patient quality of life and productivity

Heterogeneous Nucleation of Protein Crystals on Fluorinated Layered Silicate

Here, we describe an improved system for protein crystallization based on heterogeneous nucleation using fluorinated layered silicate. In addition, we also investigated the mechanism of nucleation on the silicate surface. Crystallization of lysozyme using silicates with different chemical compositions indicated that fluorosilicates promoted nucleation whereas the silicates without fluorine did not. The use of synthesized saponites for lysozyme crystallization confirmed that the substitution of hydroxyl groups contained in the lamellae structure for fluorine atoms is responsible for the nucleation-inducing property of the nucleant. Crystallization of twelve proteins with a wide range of pI values revealed that the nucleation promoting effect of the saponites tended to increase with increased substitution rate. Furthermore, the saponite with the highest fluorine content promoted nucleation in all the test proteins regardless of their overall net charge. Adsorption experiments of proteins on the saponites confirmed that the density of adsorbed molecules increased according to the substitution rate, thereby explaining the heterogeneous nucleation on the silicate surface

Consumo y costo de antimicrobianos con consideraciones especiales de uso en pacientes hospitalizados, Hospital Vitarte, 2017-2018

Evalúa el consumo de los antimicrobianos con consideraciones especiales de uso en pacientes hospitalizados en el Hospital Vitarte durante los años 2017 y 2018. Se trató de un estudio descriptivo, retrospectivo y transversal, cuantitativo de diseño no experimental. Las unidades de análisis fueron cada una de las prescripciones de antimicrobianos con consideraciones especiales de uso para pacientes hospitalizados, registradas en el Sistema de Gestión Hospitalaria. Los resultados obtenidos determinan que los antimicrobianos más consumidos en el hospital Vitarte en dicho periodo fueron meropenem (23,7%) ciprofloxacino (22,2%) y metronidazol (20,9%). Asimismo, el consumo del año 2018 significó un incremento en 16% con respecto al año 2017. Con respecto al costo, los antimicrobianos que demandaron mayor inversión fueron: meropenem (47,30%), vancomicina (16,35%) y metronidazol (8,98%) en relación al costo global, además el año 2018 se registró un incremento de 25,1% en el costo total con respecto al año 2017. Los diagnósticos más frecuentes que propiciaron las prescripciones de antimicrobianos fueron: apendicitis aguda (26,6%), neumonía (12,1%), enfermedades de la vesícula biliar (11,2%), infecciones del tracto urinario (6,8%), septicemias (7,5%) e insuficiencia respiratoria aguda (5,7%). Las conclusiones son; el consumo de antimicrobianos tiene una tendencia creciente, con variabilidad entre antimicrobianos; los tres antimicrobianos más frecuentes representan un consumo mayor del 50% del total dispensado. El costo generado por los antimicrobianos tiene una tendencia creciente. Los dos antimicrobianos más frecuentes tienen un consumo superior al 50% del total. Los principales diagnósticos que requirieron terapia antimicrobiana correspondieron a patologías transmisibles como no transmisibles, a su vez las tres patologías más frecuentes identificadas representaron más del 50% de casos totales.Trabajo académic

In Silico Prediction of Human Pathogenicity in the γ-Proteobacteria

BACKGROUND: Although the majority of bacteria are innocuous or even beneficial for their host, others are highly infectious pathogens that can cause widespread and deadly diseases. When investigating the relationships between bacteria and other living organisms, it is therefore essential to be able to separate pathogenic organisms from non-pathogenic ones. Using traditional experimental methods for this purpose can be very costly and time-consuming, and also uncertain since animal models are not always good predictors for pathogenicity in humans. Bioinformatics-based methods are therefore strongly needed to mine the fast growing number of genome sequences and assess in a rapid and reliable way the pathogenicity of novel bacteria. METHODOLOGY/PRINCIPAL FINDINGS: We describe a new in silico method for the prediction of bacterial pathogenicity, based on the identification in microbial genomes of features that appear to correlate with virulence. The method does not rely on identifying genes known to be involved in pathogenicity (for instance virulence factors), but rather it inherently builds families of proteins that, irrespective of their function, are consistently present in only one of the two kinds of organisms, pathogens or non-pathogens. Whether a new bacterium carries proteins contained in these families determines its prediction as pathogenic or non-pathogenic. The application of the method on a set of known genomes correctly classified the virulence potential of 86% of the organisms tested. An additional validation on an independent test-set assigned correctly 22 out of 24 bacteria. CONCLUSIONS: The proposed approach was demonstrated to go beyond the species bias imposed by evolutionary relatedness, and performs better than predictors based solely on taxonomy or sequence similarity. A set of protein families that differentiate pathogenic and non-pathogenic strains were identified, including families of yet uncharacterized proteins that are suggested to be involved in bacterial pathogenicity