Comparative Cost-Effectiveness Analysis Of Streptomycin And Ethambutol In The Treatment Of Tuberculosis In A University Teaching Hospital In Nigeria

Healthcare organizations, governments and individuals have been forced by prevailing circumstances of economic crisis to be increasingly oriented towards cost containment due to escalating nature of health expenditure. Objective: The objective of this study is to determine the comparative cost effectiveness of various antituberculous therapeutic options and to make recommendation for the adoption of costeffectiveness evaluations in National Health Policy formulation and decision-making. Method Retrospective cost effectiveness analysis was carried out for prescribed/dispended antibiotic to outpatients with tuberculosis among other infectious diseases in outpatients case notes between 2005 and 2007 in Ahmadu Bello University Teaching Hospital, Zaria Nigeria. Results The result shows that ethambutol tablet cost N8.40/unit of effectiveness while streptomycin injection cost N81.50/unit of effectiveness in the treatment of tuberculosis. Ethambutol tablet therefore appears to be more cost effective than streptomycin injection. Subjecting the cost and effectiveness to sensitivity analysis did not change this conclusion. Statistical analysis shows that there is a statistically significant difference in the effectiveness (outcome) of ethambutol (95%) and streptomycin injection (76.73%) (X2 =13.75;

Key stakeholders’ perspectives towards UK new-build housing defects

Purpose: Research on housing defects has limited its enquiry to the classifications of defects, potential impact of defects, and their detection and remediation during construction and the builder’s liability period, without considering the warranty period. This paper aims to better understand which impacts of defects are perceived as important by the key stakeholders involved in their detection and remediation over the construction, builder’s liability and insurer’s warranty periods. Design/methodology/approach: The questionnaire survey approach was used. The questionnaire distribution list was drawn from the UK’s largest warranty provider and approved inspector’s records. The questionnaire was distributed to 2003 people, receiving 292 responses, a response rate of 15%. Findings: This research challenges the assertion that the house building industry (i.e. house builders, building inspectors and warranty providers) is predominantly cost focused and finds that the potential impact of defects on home occupants are their primary concern. In contrast, the home occupants’ appear solely focused on the disruption defects caused on their daily lives and perceive a lack customer focus in the house building industry. Originality/value: This study provides empirical evidence of the contrasting view of the house building industry and home occupants with respect to the prioritisation of the impacts of defects. Further, this research offers house builders an alternative approach to determine which defects should be targeted for reduction purposes which may lead to improved levels of customer satisfaction

WSB1 and IL21R Genetic Variants Are Involved in Th2 Immune Responses to Ascaris lumbricoides.

Genetic and epigenetic factors are considered to be critical for host-parasite interactions. There are limited data on the role of such factors during human infections with Ascaris lumbricoides. Here, we describe the potential role of genetic factors as determinants of the Th2 immune response to A. lumbricoides in Brazilian children. Stool samples were collected from the children to detect A. lumbricoides by microscopy and peripheral blood leukocytes (PBLs) were cultured in whole blood cultures for detection of cytokines (IL-5, IL-10, and IL-13) in vitro. Levels of anti-A. lumbricoides IgE and IgG4 were measured in plasma. DNA was extracted from PBLs and genotyped using Illumina 2.5 Human Omni Beadchip. Candidate genes associated with A. lumbricoides responses were identified and SNVs in these selected genes associated with the Th2 immune response to A. lumbricoides. Haplotype, gene expression, and epigenetic analyses were done to identify potential associations with Th2 immune responses. GWAS on samples from 1,189 children identified WSB1 as a candidate gene, and IL-21R was selected as a biologically relevant linked gene for further analysis. Variants in WSB1 and IL21R were associated with markers of Th2 immune responses: increased A. lumbricoides-specific IgE and IL-5/IL-13 by PBLs from infected compared to uninfected individuals. In infected children, WSB1 but not IL21R gene expression was suppressed and increased methylation was observed in the WSB1 promoter region. This is the first study to show an association between genetic variants in WSB1 and IL21R and Th2 immune responses during A. lumbricoides infections in children. WSB1/IL21R pathways could provide a potential target for the treatment of Th2-mediated diseases

Targeted Ablation of Oligodendrocytes Triggers Axonal Damage

Glial dysfunction has been implicated in a number of neurodegenerative diseases. In this study we investigated the consequences of glial and oligodendrocyte ablation on neuronal integrity and survival in Drosophila and adult mice, respectively. Targeted genetic ablation of glia was achieved in the adult Drosophila nervous system using the GAL80-GAL4 system. In mice, oligodendrocytes were depleted by the injection of diphtheria toxin in MOGi-Cre/iDTR double transgenic animals. Acute depletion of oligodendrocytes induced axonal injury, but did not cause neuronal cell death in mice. Ablation of glia in adult flies triggered neuronal apoptosis and resulted in a marked reduction in motor performance and lifespan. Our study shows that the targeted depletion of glia triggers secondary neurotoxicity and underscores the central contribution of glia to neuronal homeostasis. The models used in this study provide valuable systems for the investigation of therapeutic strategies to prevent axonal or neuronal damage

Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme.

Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non-atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non-atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource-poor settings where the disease burden is greatest

Regeneration of myelin sheaths of normal length and thickness in the zebrafish CNS correlates with growth of axons in caliber

Demyelination is observed in numerous diseases of the central nervous system, including multiple sclerosis (MS). However, the endogenous regenerative process of remyelination can replace myelin lost in disease, and in various animal models. Unfortunately, the process of remyelination often fails, particularly with ageing. Even when remyelination occurs, it is characterised by the regeneration of myelin sheaths that are abnormally thin and short. This imperfect remyelination is likely to have implications for the restoration of normal circuit function and possibly the optimal metabolic support of axons. Here we describe a larval zebrafish model of demyelination and remyelination. We employ a drug-inducible cell ablation system with which we can consistently ablate 2/3rds of oligodendrocytes in the larval zebrafish spinal cord. This leads to a concomitant demyelination of 2/3rds of axons in the spinal cord, and an innate immune response over the same time period. We find restoration of the normal number of oligodendrocytes and robust remyelination approximately two weeks after induction of cell ablation, whereby myelinated axon number is restored to control levels. Remarkably, we find that myelin sheaths of normal length and thickness are regenerated during this time. Interestingly, we find that axons grow significantly in caliber during this period of remyelination. This suggests the possibility that the active growth of axons may stimulate the regeneration of myelin sheaths of normal dimensions

Why there and then, not here and now? Ecological offsetting in California and England, and the sharpening contradictions of neoliberal natures

Failure has become an increasingly important theme of debate in the literature on neoliberal natures. In this article we take up this topic with respect to ecological offsetting, often regarded as an exemplar of market-oriented conservation. Comparing the case of species banking which emerged in California in the 1990s with frustrated efforts to implement a biodiversity offsetting programme in England beginning in 2010, we develop a novel analytical framework for explaining why this kind of environmental market-making may or may not be successful in different contexts. Drawing on work in geography on the neoliberalisation of nature and insights from economic sociology, we characterise ecological offsetting as ‘command-and-commodify’ regulation: a peculiar form of hybrid ecological regulation which depends on an institutional mix of ‘authoritative’ and ‘economic’ power to function. In California, these kinds of environmental markets initially emerged at a moment of compromise, contingent on an embrace of ‘market’ solutions to environmental problems on the one hand, and a somewhat paradoxical expansion of authoritative power to ecologically regulate land development, on the other. In England, by contrast, deep fiscal austerity and deregulatory zeal, combined with resistance from nearly every quarter, initially undermined the possibility of balancing economic and authoritative power, which we argue is necessary for the construction of viable ecological offsetting. Reflecting on themes in the wider literature, we conclude by questioning whether the English experience is indicative of sharpening tensions between economy and ecology in the late neoliberal era