Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6: A Preliminary Report from Istanbul

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Estimating and comparing the clinical and economic impact of paediatric rotavirus vaccination in Turkey using a simple versus an advanced model

<p>Background: The burden of rotavirus disease is high in Turkey, reflecting the large birth cohort (> 1.2 million) and the risk of disease. Modelling can help to assess the potential economic impact of vaccination. We compared the output of an advanced model with a simple model requiring fewer data inputs. If the results are similar, this could be helpful for countries that have few data available.</p><p>Methods: The advanced model was a previously published static Markov cohort model comparing costs and quality-adjusted life-year (QALY) outcomes of vaccination versus no vaccination. In contrast, the simple model used only a decision tree. Both models included data on demography, epidemiology, vaccine efficacy, resource use, unit costs, and utility scores from national databases and published papers. Only the perspective of the health care payer was considered in the analysis. The simple model had 23 variables, compared with 103 in the advanced model to allow additional comparisons of different vaccine types, dose schemes and vaccine waning.</p><p>Results: With the same input data, both models showed that rotavirus vaccination in Turkey would improve health outcomes (fewer QALYs lost to rotavirus disease). The projected annual cost offsets were $29.9 million in the simple and$29.4 million in the advanced model. Sensitivity analysis indicated that in both models the main cost driver was disease incidence followed by cost for hospital care and medical visits. Vaccine efficacy had a smaller effect.</p><p>Conclusion: Both models reached similar conclusions. Both projected that rotavirus vaccination in Turkey would improve health outcomes and may result in savings in direct healthcare costs to offset the cost of vaccination. The analysis indicated that the simple model can produce meaningful economic results in conditions where few data are available. (c) 2012 Elsevier Ltd. All rights reserved.</p>

Clinical Significance of Human Metapneumovirus in Refractory Status Epilepticus and Encephalitis: Case Report and Review of the Literature

Encephalitis is a complex neurological disease that is associated with significant morbidity and mortality, and the etiology of the disease is often not identified. Human metapneumovirus (hMPV) is a common cause of upper and lower respiratory tract infections in children. Few reports are available showing possible involvement of hMPV in development of neurologic complications. Here, we describe an infant, the youngest case in literature, with refractory status epilepticus and severe encephalitis in whom hMPV was detected in respiratory samples and review diagnostic workup of patient with encephalitis

Estado oxidante e antioxidante de crianças com bronquiolite aguda

OBJETIVO: O estresse oxidativo demonstrou contribuir para a patogênese de doenças pulmonares inflamatórias agudas e crônicas. Nosso objetivo foi avaliar o estado oxidante/antioxidante de crianças com bronquiolite aguda por meio de mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. MÉTODOS: As crianças com bronquiolite aguda encaminhadas para o Departamento de Emergência Pediátrica do hospital universitário entre janeiro e abril 2012 foram comparadas a controles saudáveis de mesma idade. Os pacientes com bronquiolite aguda tiveram essa doença classificada como leve e moderada. O estado oxidante e antioxidante foi avaliado pela mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. RESULTADOS: Foram incluídas 31 crianças com bronquiolite aguda com idade de três meses a dois anos e 37 crianças saudáveis. O estado oxidante total (EOT) foi maior em pacientes com bronquiolite aguda do que no grupo de controle (5,16±1,99 µmol H2O2 em comparação a 3,78±1,78 µmol H2O2 [p = 0,004]). A capacidade antioxidante total (CAT) foi significativamente menor em crianças com bronquiolite que no grupo de controle (2,51±0,37 µmol Trolox equivalente/L em comparação a 2,75±0,39 µmol Trolox Eqv/L) (p = 0,013). Os pacientes com bronquiolite moderada apresentaram níveis de EOT mais elevados que os com bronquiolite leve e os do grupo de controle (p = 0,03, p < 0,001). Os pacientes com bronquiolite moderada apresentaram níveis de IEO mais elevados que os do grupo de controle (p = 0,015). O nível de saturação de oxigênio de pacientes com bronquiolite foi inversamente correlacionado ao nível de EOT (r = -0,476, p < 0,05). CONCLUSÃO: O equilíbrio entre os sistemas oxidante e antioxidante é interrompido em crianças com bronquiolite moderada, indicando que o fator de estresse poderá ter um papel na patogênese da doença