FISHBURNE's METHOD AND THE CLASSICAL METHOD OF PHARMACOECONOMIC ANALYSIS IN THE EVALUATION OF ANTIBIOTIC TREATMENT OF ACUTE AND RECURRENT BRONCHITIS IN CHILDREN

Objective: This study was performed in order to estimate clinical effectiveness of antibiotic therapy in acute and recurrent obstructive bronchitis. For estimation the following was used: the Fishbern method of antibiotics distribution according to clinical effectiveness levels with the help of weighted coefficients and classical cost–efficiency†pharmacoeconomic analysis of the given antibiotic therapy. Then, for the first time ever, the obtained results of both methods were combined.Methods: Materials were presented by the data on antibiotic therapy, given for patients who were hospitalized to the in-patient medical facilities due to acute or recurrent obstructive bronchitis. Medical records of 2 259 patients were included in the study. The patients were 0 to 18 y old. In order to determine the weighed coefficients of each used antibiotic with subsequent distribution according to the levels of clinical effectiveness the Fishbern method was applied. Three levels of clinical effectiveness were used in this study, i.e. high, medium and low. The cost–efficiency†pharmacoeconomic analysis was applied to combine costs and efficiency of the compared therapy courses in acute and recurrent obstructive bronchitis.Results: Finally we found out that the highest probability of positive effect of cephalosporins group agents was associated with the use of Cefotaximum. (Biosynthesis). From the pharmacoeconomic point of view the most effective in treating acute and recurrent obstructive bronchitis in children in the in-patient facilities was Ceftriaxonum (Synthesis). Out of protected penicillins group, we used Amoxicillin/clavulanic acid–original drug Augmentin (Smithkline Beecham Pharmaceuticals) and generic drug Amoxiclav (Lek d. d). Augmentin effectiveness was 0.591, and Amoxiclav effectiveness–0.530. Cost of Augmentin treatment course was 106.26 rub. (1.68 US$), cost of Amoxiclav treatment course–103.50 rub.(1.63 US$). Augmentin use turned out to be the most reasonable. Augmentin treatment course was characterized by lower ICER coefficient versus Amoxiclav. We found out that from the pharmacoeconomic point of view Azitromicin (Vertex Ltd.) treatment turned out to be the most reasonable of the whole macrolides antibiotics for treatment of acute and recurrent obstructive bronchitis. However, according to the Fishbern clinical effectiveness classification this antibiotic belonged to the group with medium effectiveness level. The group with high effectiveness level included Sumamed, Azitral, Hemomicin, Clacid, Zitrocin and Clabax. Clacid and Clabax were excluded during the pharmacoeconomic analysis. The highest value of ICER coefficient was obtained for Sumamed and made up 39,367.50 rub. (621.53 US$). The highest level of clinical effectiveness was characteristic for Sumamed as well. Besides Sumamed was an original drug of azitromicin. According to the obtained data Azitral and Hemomicin had the lowest values of ICER coefficient (1151.67 rub. (18.18 US$) and 1812.22 rub. (28.61 US$) respectively). Therefore based on the clinical economic analysis these medical agents turned out to be the most suitable.Conclusion: The results of the pharmacoeconomic analysis showed that the most effective drugs in treatment of acute and recurrent obstructive bronchitis in children in in-patient facilities appeared to be the following: out of cephalosporins-Ceftriaxonum (Synthesis), out of protected penicillins-Augmentin (Smithkline Beecham Pharmaceuticals), out of macrolides-Azitromicin (Vertex Ltd.). According to the Fishbern classification, these drugs belonged to the group with medium level of effectiveness.Â

ROLE OF "ATYPICAL" MICROORGANISMS ON THE FORMATION OF BRONCHIAL ASTHMA IN CHILDREN WITH ACUTE AND RECURRENT OBSTRUCTIVE BRONCHITIS

Objective: This study was undertaken to determine the link between the presence of atypical†infections in patients with acute obstructive andrecurrent obstructive bronchitis (AOB/ROB) and bronchial asthma (BA) development based on the concept of risk.Methods: The materials for the study were the data records of patients hospitalized with AOB or ROB and whose analysis was performed to identifyantibodies to atypical†microflora (796 patients). The study period was 4 years from 2008 to 2011. In the analyzed period, immunosorbent assay forthe detection of antibodies to atypical†microflora (Chlamydophila pneumoniae, Mycoplasma pneumoniae, Mycoplasma hominis) was performed. Theconcept of risk identification was based on the determination of the absolute risk, attributable risk (AtR), relative risk, population attributable risk, aswell as on the definition of the standard errors for each type of risk and the confidence interval.Results and Conclusion: Methodical aspects of determining the relationship between the presence of atypical†infections in patients with AOBor ROB and BA development were based on the concept of risk. The analysis showed a direct link between the increase of cases of BA formationagainst the backdrop of atypical†infections. Therefore, the performed analysis of atypical pathogens influences on BA occurrence in patients withAOB/ROB which indicates direct dependence increase of BA incidence on atypical infection. In experimental group, Frequency of event is 14.84% inexperimental group. Frequency of event is 1.67% in control group. The risk factor increases probability of event by 13.17%, the risk factor increasesprobability of event by 13.17%. Presence of atypical infection leads to increase of BA incidence by 8.9 times. Number needed to harm (NNH) is 7.59,i.e., in the presence of atypical infection in patients with AOB/ROB, each eighth exposed person develops BA in addition to background level of BAincidence.Keywords: Acute obstructive bronchitis, Recurrent obstructive bronchitis, Bronchial asthma, The concept of risk, Risk factor, The absolute risk,Relative risk, Attributable risk, Population attributable risk, Number needed to harm

Фармакоэпидемиологический DDD-, DU90%-анализ антимикробной терапии внебольничной пневмонии в условиях стационаров федерального и муниципального подчинения

This study was designed to compare results of pharmacoepidemiological analysis of antibacterial therapy in patients with community-acquired pneumonia (CAP) admitted to hospitals of Nizhniy Novgorod. Methods. Data for analysis were obtained from medical records of all patients with CAP (n = 117; 51.3% were males) admitted to two city hospitals in 2015 and 2016. Therapy of CAP was in agreement with corresponding standards. We analyzed real drug utilization using the defined daily dose (DDD) and drug utilization accounting for 90% of the total amount of DDD prescribed (DU90%).Results. Penicillinase-resistant penicillins, the 3rd generation cephalosporins and fluoroquinolones were the most often prescribed antibiotics in hospitals. The highest number of DDD was for ceftriaxone (376.0 g) in the hospital 1 and levofloxacin (468.16 g) in the hospital 2. The drugs constituting 90% of the prescription volume for inpatient therapy of CAP were ceftriaxone (46.09%), levofloxacin (20.0%), azythromycin (9.19%), and ciprofloxacin (9.19%) in the hospital 1 and ceftriaxone (16.50%), levofloxacin (71.19%), and ertapenem (4.70%) in the hospital 2. In the hospital 1, the cost of one DDD in DU10% segment (982.12 RUB) was 4-fold higher than that in DU90% segment (200.0 RUB); this suggests that inexpensive drugs were predominantly used in the hospital 1. In the hospital 2, DU10% consisted of two drugs accounting 24.56% of the total prescriptions. The cost of one DDD in DU90% segment (6 022.88 RUB) was 1.9-fold higher than that in DU10% segment (3 166.73 RUB); this suggests that more expensive antibiotics were widely used in the hospital 2. Conclusion. The strategy used in the hospital 2 is recommended according to the study results. The initial therapy with a single antibiotic could significantly reduce the drug load for the patient. Addition of the second antibiotic to the treatment was needed in 15% only, though patients were admitted to a hospital after the treatment failure both in ambulatory settings and in other hospitals.Цель исследования заключалось в сопоставлении результатов фармакоэпидемиологического анализа антимикробной терапии (АМТ) внебольничной пневмонии (ВП) в 2 стационарах Нижнего Новгорода различного уровня подчинения. Материалы и методы. Материалом для исследования послужили данные историй болезни пациентов с ВП (n = 117: 51,3 % – мужчины, 48,7 % – женщины), госпитализированных в Государственное бюджетное учреждение здравоохранения Нижегородской области «Городскаяклиническаябольница№ 5 Нижегородского района городаНижнегоНовгорода» в 2015 г. (стационар 1) и Федеральное бюджетное учреждение здравоохранения «Приволжский окружной медицинский центр» Федерального медико-биологического агентства (Нижний Новгород) в 2016 г. (n = 48) (стационар 2). В исследование были включены все больные, госпитализированные в стационар за анализируемый период. Терапия ВП осуществлялась в соответствии со стандартами лечения. При проведении ретроспективной фармакоэпидемиологической оценки анализировались фактическое потребление лекарственных средств (ЛС) на основе установленной суточной дозы (DDD-анализ) и потребление ЛС на основе их доли в общем числе установленных суточных доз (DU90%-анализ). Результаты. Наибольшее число назначений в стационаре 1 приходится на защищенные пенициллины и цефалоспорины III поколения, в стационаре 2 – на цефалоспорины III поколения и фторхинолоны. Самое большое значение числа установленных суточных доз (number of determined daily doses – NDDD) в стационаре 1 соответствует цефтриаксону (NDDD = 376,0 г), в стационаре 2 – левофлоксацину (NDDD = 468,16 г). В группу, составляющую 90 % всех потребляемых NDDD антимикробных препаратов (АМП) при ВП в стационаре 1, вошли цефтриаксон (46,09 %), левофлоксацин (20,0 %), азитромицин (9,19 %), ципрофлоксацин (9,19 %); в стационаре 2 – левофлоксацин (71,19 %), цефтриаксон (16,50 %), эртапенем (4,70 %). Стоимость 1 DDD в сегменте DU10% (982,12 руб.) более чем в 4 раза превышает таковую в сегменте DU90% (200,0 руб.), что позволяет говорить о преимущественном использовании недорогих по стоимости ЛС в стационаре 1. В сегмент DU10% в стационаре 2 вошли ЛС, доля которых в реальной структуре назначений составила 24,56 %. Стоимость 1 DDD в сегменте DU90% (6 022,88 руб.) в 1,9 раза превышает таковую в сегменте DU10% (3 166,73 руб.), что позволяет говорить о широком использовании дорогостоящих ЛС в стационаре 2.Заключение. По результатам проведенного анализа рекомендуется использовать опыт терапии ВП стационара 2. При использовании монотерапии в качестве стартовой значительно снижается лекарственная нагрузка на пациента. Введение дополнительного ЛС в схему лечения отмечено лишь в 15 % случаев, при этом в стационар 2 госпитализированы больные, у которых предшествующая АМТ, проводимая как амбулаторно, так и в условиях других стационаров, была неэффективной. Преемственность опыта АМТ связана со значительным увеличением затрат на АМП. Так, стоимость 1 DDD АМП в сегменте DU90%, используемой в стационаре 1 в 2015 г., составила 200,0 руб., в то время как стоимость 1 DDD в стационаре 2 – 6 022,88 руб

Non-vector-borne transmission of lumpy skin disease virus

The transmission of “lumpy skin disease virus” (LSDV) has prompted intensive research efforts due to the rapid spread and high impact of the disease in recent years, especially in Eastern Europe and Balkan countries. In this study, we experimentally evaluate the vaccine-derived virulent recombinant LSDV strain (Saratov/2017) and provide solid evidence on the capacity of the virus for transmission in a vectorproof environment. In the 60-day long experiment, we used inoculated bulls (IN group) and two groups of in-contact animals (C1 and C2), with the former (C1) being in contact with the inoculated animals at the onset of the trial and the latter (C2) being introduced at day 33 of the experiment. The infection in both groups of contact animals was confirmed clinically, serologically and virologically, and viremia was demonstrated in blood, nasal and ocular excretions, using molecular tools. Further studies into LSDV biology are a priority to gain insights into whether the hypothesized indirect contact mode evidenced in this study is a de novo-created feature, absent from both parental stains of the novel (recombinant) LSDV isolate used, or whether it was dormant, but then unlocked by the process of genetic recombination. Author summary: In global terms, LSD has been termed a “neglected disease” due to its historic natural occurrence of being restricted to Africa and, occasionally, Israel. However, after its slow spread throughout the Middle East, the disease is now experiencing a resurgence of research interest following a recent and rapid spread into more northern latitudes. Given the dearth of solid findings on potential transmission mechanisms, no efficient or reliable control program currently exists, which does not involve the use of live attenuated vaccines or stamping out policies – both of which are controversial for implementation in non-endemic regions or countries. The vector-borne mode is the only working concept currently available, but with scarce evidence to support the aggressive spread northwards – except for human-assisted spread, including legal or illegal animal transportation. The emergence of outbreaks is not consistently linked to weather conditions, with the potential for new outbreaks to occur and spread rapidly. Here, for the first time, we provide evidence for indirect contact-mode transmission for a naturally-occurring recombinant LSDV isolated from the field. In an insect-proof facility, we obtained solid evidence that the novel LSDV strain can pass to in-contact animals. Given the recombinant nature of the virus utilised, its genetic background relating to the observed transmission pattern within the study needs to be delineated.http://www.nature.com/srepam2021Veterinary Tropical Disease

Detection of tick-borne pathogens in wild birds and their ticks in Western Siberia and high level of their mismatch

Abstract: The Tomsk region located in the south of Western Siberia is one of the most high-risk areas for tick-borne diseases due to elevated incidence of tick-borne encephalitis and Lyme disease in humans. Wild birds may be considered as one of the reservoirs for tick-borne pathogens and hosts for infected ticks. A high mobility of wild birds leads to unpredictable possibilities for the dissemination of tick-borne pathogens into new geographical regions. The primary goal of this study was to evaluate the prevalence of tick-borne pathogens in wild birds and ticks that feed on them as well as to determine the role of different species of birds in maintaining the tickborne infectious foci. We analysed the samples of 443 wild birds (60 species) and 378 ticks belonging to the genus Ixodes Latraille, 1795 collected from the wild birds, for detecting occurrence of eight tick-borne pathogens, the namely tick-borne encephalitis virus (TBEV), West Nile virus (WNV), and species of Borrelia, Rickettsia, Ehrlichia, Anaplasma, Bartonella and Babesia Starcovici, 1893, using RT-PCR/or PCR and enzyme immunoassay. One or more tick-borne infection markers were detected in 43 species of birds. All markers were detected in samples collected from fieldfare Turdus pilaris Linnaeus, Blyth’s reed warbler Acrocephalus dumetorum Blyth, common redstart Phoenicurus phoenicurus (Linnaeus), and common chaffinch Fringilla coelebs Linnaeus. Although all pathogens have been identified in birds and ticks, we found that in the majority of cases (75.5%), there were mismatches of pathogens in birds and ticks collected from them. Wild birds and their ticks may play an extremely important role in the dissemination of tick-borne pathogens into different geographical regions

Dynamical Effects in Process of Piles Vibrodriving

Vibration driving of elements into a soil is a complex mechanical process, accompanied with such phenomena, as a changing of structure of surrounding the driving element soil, liquefaction of them, the decreasing of friction forces between soil and surface of the driving element. A vibration method is used for driving of elements with the comparatively small cross section area: metallic sheet piles and pipes; length of sinking elements is not limited. When periodically changing axial force is acting on the driving elements there is possibility of loss of dynamical stability of element because of parametric resonance. Such possibility appears when motion of element bottom end is obstructed by the layers of very hard soil (for example, rocky) or because of densification of the liquefied sandy soil after technological pause in vibrodriving. In this work it is suggested to check up the parameters of vibrators using the simulation of pile driving process and examination of pile dynamical stability. The plastic model of shaft and toe resistance of soils during vibrodriving is developed taking into account the change of properties of soils on the depth, equation of motion of pile in soil is derived and solved numerically. The analysis of numerical solution shows the possibility of element driving to required depth by one vibrator with given performance figures, or the necessity of additional static set-on-weight, additional vibrator or changing of vibrator. The possibility of origination of dynamical instability and condition of resonance is examined on the models of pile as a perfectly solid and as a flexible beam. Possibility of dynamic stability loose on the higher mode of vibrations is proved for the driving elements from the often applied metallic rolled sections, examined as flexible beams

Impact Vibration Absorber of Pendulum Type

В данной работе рассматривается ударный гаситель колебаний маятникового типа. Он представляет собой маятник, движение которого ограничено упорами, установленными на вибрирующей системе. Гасители колебаний маятникового типа используются на практике для уменьшения уровня вибраций различных инженерных сооружений: дымовых труб, телевизионных башен, мостов, высотных зданий, мачт-антенн, для атобалансировки валов и т.д. Цель данного исследования - изучить влияние параметров маятника на возможность подавления вибраций основной системы при гармоническом возбуждении

Research of the Process of Pile Driving into Soil by Means of Serial Impact

In this work pile drivability into soil is considered; for pile driving the blow action hammer is used. Post-impact translation motion of pile under gravity and resisting forces is theoretically defined: penetration of a pile into a soil per one impact and the duration of motion are calculated. It allows defining necessary time of the pile driving till the required level if the properties of soil are known. Two methods are employed: rigid body model and wave theory of impact

Rigid Body Impact Models Partially Considering Deformation

The paper deals with the low-speed impact of rigid bodies. The elasticity and damping forces, acting on a body during the impact, depend on the physical properties of the material; in this work these forces are considered according to the Kelvin-Voigt, Bingham and Maxwell models of the medium. New models of the forces, acting during the impact, are elaborated. Numerical solutions of the equations for various impact forces are obtained

Research of Piles Driving Process in Various Types of Soils by Impact Method

Process of pile s driving into soil is a complex and poorly studies problem despite of its seeming simplicity and long-duration use. The method of piles driving based on impact approach involves various types oif the drop hammers - steam, mechanical, diesel hammers and hydrohammers