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Steven G Docimo - One of the best experts on this subject based on the ideXlab platform.
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the cost effectiveness of dextranomer hyaluronic acid copolymer for the management of vesicoureteral reflux 1 substitution for surgical management
The Journal of Urology, 2006Co-Authors: Ronald M Benoit, Pamela B Peele, Steven G DocimoAbstract:Purpose: We examined the cost-effectiveness of dextranomer/hyaluronic acid copolymer injection in patients who would otherwise undergo ureteral reimplantation.Materials and Methods: A model for managing vesicoureteral reflux has previously been created. We now update the model to compare the costs of treating vesicoureteral reflux using standard methods (ie ureteral reimplantation after failed medical therapy) with the costs of dextranomer/hyaluronic acid injection.Results: In the first scenario created dextranomer/hyaluronic acid injection is substituted for ureteral reimplantation when surgical intervention would be performed for treatment of Breakthrough Infection or failure of the reflux to resolve. For dextranomer/hyaluronic acid injection to have equal cost-effectiveness compared to ureteral reimplantation in this scenario success rates for dextranomer/hyaluronic acid injection would need to be 57.8% per ureter for patients with unilateral reflux and 75.3% per ureter for patients with bilateral refl...
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The cost-effectiveness of dextranomer/hyaluronic acid copolymer for the management of vesicoureteral reflux. 1: substitution for surgical management.
Journal of Urology, 2006Co-Authors: Ronald M Benoit, Pamela B Peele, Steven G DocimoAbstract:Purpose: We examined the cost-effectiveness of dextranomer/hyaluronic acid copolymer injection in patients who would otherwise undergo ureteral reimplantation.Materials and Methods: A model for managing vesicoureteral reflux has previously been created. We now update the model to compare the costs of treating vesicoureteral reflux using standard methods (ie ureteral reimplantation after failed medical therapy) with the costs of dextranomer/hyaluronic acid injection.Results: In the first scenario created dextranomer/hyaluronic acid injection is substituted for ureteral reimplantation when surgical intervention would be performed for treatment of Breakthrough Infection or failure of the reflux to resolve. For dextranomer/hyaluronic acid injection to have equal cost-effectiveness compared to ureteral reimplantation in this scenario success rates for dextranomer/hyaluronic acid injection would need to be 57.8% per ureter for patients with unilateral reflux and 75.3% per ureter for patients with bilateral refl...
Luan-yin Chang - One of the best experts on this subject based on the ideXlab platform.
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varicella Breakthrough Infection and vaccine effectiveness in taiwan
Vaccine, 2011Co-Authors: Wen-chan Huang, Li-min Huang, I-shou Chang, Fang-yu Tsai, Luan-yin ChangAbstract:We performed this nationwide retrospective investigation among the recipients of varicella vaccine to evaluate the Breakthrough varicella Infection rate, factors associated with Breakthrough Infection and the vaccine effectiveness. The recipients of these vaccinations were identified through Taiwan's National Immunization Information System and data on Breakthrough Infections among these recipients were collected by using Taiwan's National Health Insurance Claims Database. From 2000 to 2007, 1,057,345 persons received varicella vaccinations in Taiwan. Varicella Breakthrough Infection occurred among 22,640 (2.1%) vaccinees and 170 (0.016%) required hospitalization for varicella disease. Annual Breakthrough Infection rates ranged from 0.12% to 2.04%. The mean age of vaccination was 1.6 years (median 1.3 years) and the mean age at Breakthrough Infection was 3.9 years. The mean interval between vaccination and the Breakthrough Infection was 2.3 years. The rate was significantly lower in regions where free varicella vaccinations were available than in regions where they were not (P<0.001). Varicella Breakthrough Infection was significantly more likely to occur at 5 and 6 years of age among the vaccinees, who received vaccination between 12 months and 23 months of age (P<0.001). The vaccine effectiveness against varicella was 82.6% and against varicella-related hospitalization was 85.4% from 2000 to 2005.
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Varicella Breakthrough Infection and vaccine effectiveness in Taiwan
Vaccine, 2011Co-Authors: Wen-chan Huang, Li-min Huang, I-shou Chang, Fang-yu Tsai, Luan-yin ChangAbstract:We performed this nationwide retrospective investigation among the recipients of varicella vaccine to evaluate the Breakthrough varicella Infection rate, factors associated with Breakthrough Infection and the vaccine effectiveness. The recipients of these vaccinations were identified through Taiwan's National Immunization Information System and data on Breakthrough Infections among these recipients were collected by using Taiwan's National Health Insurance Claims Database. From 2000 to 2007, 1,057,345 persons received varicella vaccinations in Taiwan. Varicella Breakthrough Infection occurred among 22,640 (2.1%) vaccinees and 170 (0.016%) required hospitalization for varicella disease. Annual Breakthrough Infection rates ranged from 0.12% to 2.04%. The mean age of vaccination was 1.6 years (median 1.3 years) and the mean age at Breakthrough Infection was 3.9 years. The mean interval between vaccination and the Breakthrough Infection was 2.3 years. The rate was significantly lower in regions where free varicella vaccinations were available than in regions where they were not (P
Gavin Cloherty - One of the best experts on this subject based on the ideXlab platform.
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Molecular and serological characterization of hepatitis B vaccine Breakthrough Infections in serial samples from two plasma donors
Virology journal, 2019Co-Authors: Mary C. Kuhns, Anne L. Mcnamara, Vera Holzmayer, Gavin ClohertyAbstract:Although vaccines for hepatitis B virus (HBV) are highly effective, HBV Infections in vaccinees occur. Index samples of Breakthrough Infections are typically anti-HBc negative but HBV DNA positive with protective anti-HBs levels while HBsAg detection may be delayed or absent. HBsAg mutations have been associated with some vaccine Breakthrough cases. This research characterizes the serological and molecular profiles of vaccine Breakthrough Infections in serial samples from two commercially available plasma donor panels. Samples were tested with commercially available assays for HBV antigens and antibodies: HBsAg, HBeAg, anti-HBc, anti-HBc IgM, anti-HBe, and anti-HBs. Different immunoassay approaches for earlier detection of Breakthrough Infection were explored including hepatitis B core-related antigen (HBcrAg), a research assay for preS2 antigen, and a new prototype ARCHITECT HBsAg assay with improved sensitivity. The prototype HBsAg assay is fully automated and involves no sample pre-treatment. Molecular testing included HBV DNA quantitation and sequencing of preS1, preS2, surface, and basal core promoter/core promoter genes. Although the research preS2 antigen assay allowed earlier detection of the Breakthrough Infections than current HBsAg assays and HBcrAg, the new prototype ARCHITECT HBsAg assay provided the earliest serologic detection. The ability of the new prototype HBsAg assay to detect HBsAg in the presence of anti-HBs was investigated using known concentrations of native HBsAg mixed with anti-HBs from a vaccinee. The results demonstrated that the prototype ARCHITECT assay is more sensitive in detecting HBsAg in the presence of anti-HBs than current HBsAg assays. Sequencing revealed multiple substitutions in preS1, preS2, and S regions for one panel including a rare D144N substitution associated with vaccine Breakthrough that emerged with increasing frequency as the Breakthrough Infection developed. When compared with other immunoassay approaches, the new prototype ARCHITECT HBsAg assay allows earlier detection of vaccine Breakthrough Infections and more sensitive detection of HBsAg in the presence of anti-HBs. Molecular characterization of longitudinal samples demonstrated the progressive appearance of a rare HBsAg mutation associated with vaccine Breakthrough.
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Molecular and serological characterization of hepatitis B vaccine Breakthrough Infections in serial samples from two plasma donors
BMC, 2019Co-Authors: Mary C. Kuhns, Anne L. Mcnamara, Vera Holzmayer, Gavin ClohertyAbstract:Abstract Background Although vaccines for hepatitis B virus (HBV) are highly effective, HBV Infections in vaccinees occur. Index samples of Breakthrough Infections are typically anti-HBc negative but HBV DNA positive with protective anti-HBs levels while HBsAg detection may be delayed or absent. HBsAg mutations have been associated with some vaccine Breakthrough cases. Methods This research characterizes the serological and molecular profiles of vaccine Breakthrough Infections in serial samples from two commercially available plasma donor panels. Samples were tested with commercially available assays for HBV antigens and antibodies: HBsAg, HBeAg, anti-HBc, anti-HBc IgM, anti-HBe, and anti-HBs. Different immunoassay approaches for earlier detection of Breakthrough Infection were explored including hepatitis B core-related antigen (HBcrAg), a research assay for preS2 antigen, and a new prototype ARCHITECT HBsAg assay with improved sensitivity. The prototype HBsAg assay is fully automated and involves no sample pre-treatment. Molecular testing included HBV DNA quantitation and sequencing of preS1, preS2, surface, and basal core promoter/core promoter genes. Results Although the research preS2 antigen assay allowed earlier detection of the Breakthrough Infections than current HBsAg assays and HBcrAg, the new prototype ARCHITECT HBsAg assay provided the earliest serologic detection. The ability of the new prototype HBsAg assay to detect HBsAg in the presence of anti-HBs was investigated using known concentrations of native HBsAg mixed with anti-HBs from a vaccinee. The results demonstrated that the prototype ARCHITECT assay is more sensitive in detecting HBsAg in the presence of anti-HBs than current HBsAg assays. Sequencing revealed multiple substitutions in preS1, preS2, and S regions for one panel including a rare D144N substitution associated with vaccine Breakthrough that emerged with increasing frequency as the Breakthrough Infection developed. Conclusions When compared with other immunoassay approaches, the new prototype ARCHITECT HBsAg assay allows earlier detection of vaccine Breakthrough Infections and more sensitive detection of HBsAg in the presence of anti-HBs. Molecular characterization of longitudinal samples demonstrated the progressive appearance of a rare HBsAg mutation associated with vaccine Breakthrough
Ronald M Benoit - One of the best experts on this subject based on the ideXlab platform.
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the cost effectiveness of dextranomer hyaluronic acid copolymer for the management of vesicoureteral reflux 1 substitution for surgical management
The Journal of Urology, 2006Co-Authors: Ronald M Benoit, Pamela B Peele, Steven G DocimoAbstract:Purpose: We examined the cost-effectiveness of dextranomer/hyaluronic acid copolymer injection in patients who would otherwise undergo ureteral reimplantation.Materials and Methods: A model for managing vesicoureteral reflux has previously been created. We now update the model to compare the costs of treating vesicoureteral reflux using standard methods (ie ureteral reimplantation after failed medical therapy) with the costs of dextranomer/hyaluronic acid injection.Results: In the first scenario created dextranomer/hyaluronic acid injection is substituted for ureteral reimplantation when surgical intervention would be performed for treatment of Breakthrough Infection or failure of the reflux to resolve. For dextranomer/hyaluronic acid injection to have equal cost-effectiveness compared to ureteral reimplantation in this scenario success rates for dextranomer/hyaluronic acid injection would need to be 57.8% per ureter for patients with unilateral reflux and 75.3% per ureter for patients with bilateral refl...
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The cost-effectiveness of dextranomer/hyaluronic acid copolymer for the management of vesicoureteral reflux. 1: substitution for surgical management.
Journal of Urology, 2006Co-Authors: Ronald M Benoit, Pamela B Peele, Steven G DocimoAbstract:Purpose: We examined the cost-effectiveness of dextranomer/hyaluronic acid copolymer injection in patients who would otherwise undergo ureteral reimplantation.Materials and Methods: A model for managing vesicoureteral reflux has previously been created. We now update the model to compare the costs of treating vesicoureteral reflux using standard methods (ie ureteral reimplantation after failed medical therapy) with the costs of dextranomer/hyaluronic acid injection.Results: In the first scenario created dextranomer/hyaluronic acid injection is substituted for ureteral reimplantation when surgical intervention would be performed for treatment of Breakthrough Infection or failure of the reflux to resolve. For dextranomer/hyaluronic acid injection to have equal cost-effectiveness compared to ureteral reimplantation in this scenario success rates for dextranomer/hyaluronic acid injection would need to be 57.8% per ureter for patients with unilateral reflux and 75.3% per ureter for patients with bilateral refl...
Naoyuki Katayama - One of the best experts on this subject based on the ideXlab platform.
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fatal trichosporon fungemia in patients with hematologic malignancies
European Journal of Haematology, 2010Co-Authors: Kei Suzuki, Kazunori Nakase, Taiichi Kyo, Tadahiro Kohara, Yumiko Sugawara, Tetsunori Shibazaki, Kouji Oka, Tetsuya Tsukada, Naoyuki KatayamaAbstract:Objective Invasive Trichosporon Infection has been increasingly recognized in patients with hematologic malignancies. Our study aims to clarify the clinical characteristics of this disease and factors influencing patient prognosis. Patients and methods We retrospectively analyzed 33 cases of Trichosporon fungemia (TF) in patients with hematologic malignancies treated at our collaborating five hospitals in Japan between 1992 and 2007. Results The majority of these patients had acute leukemia (82%), neutropenia (85%), and a history of intensive chemotherapy (91%). TF occurred as a Breakthrough Infection during antifungal therapy in 30 patients (91%), 18 of whom were receiving micafungin. The surveillance cultures of most patients were negative for Trichosporon. Only a few patients exhibited elevated levels of 1,3-beta-d-glucan before positive blood culture. Twenty-five patients (76%) died of this Infection. The resolution of Infection was associated with neutrophil recovery (P = 0.0001), absence of hyperglycemia (P = 0.023), and azole inclusive therapy (P = 0.031). Survival was significantly longer in patients receiving antifungal therapies containing azole than in those who did not receive azole (P = 0.0034). Conclusions At present, the diagnosis of invasive trichosporonosis depends on blood culture studies, and the mortality of this disease is high; however, azole therapy and control of blood glucose level, together with hematopoietic recovery could help in improving the clinical outcome. When we use antifungals lacking anti-Trichosporon activity, sufficient care should be taken to prevent the development of Breakthrough trichosporonosis.
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Breakthrough disseminated zygomycosis induced massive gastrointestinal bleeding in a patient with acute myeloid leukemia receiving micafungin
Journal of Infection and Chemotherapy, 2009Co-Authors: Kei Suzuki, Kazunori Nakase, Yumiko Sugawara, Takao Sekine, Naoyuki KatayamaAbstract:A 69-year-old man, who had been receiving prednisolone for 11 months for treatment of interstitial pneumonia, was diagnosed with acute myeloid leukemia. During induction therapy, he developed severe pneumonia. Although meropenem and micafungin were started, he died of circulatory failure owing to massive gastrointestinal bleeding. Autopsy specimens obtained from the stomach revealed fungal hyphae, which had invaded diffusely into submucosal vessels and caused the massive gastric bleeding. The same hyphae were also observed in both lungs. A diagnosis of disseminated zygomycosis was confirmed by its characteristic histopathological findings. Because zygomycetes are spontaneously resistant to the newer antifungal agents, such as voriconazole or micafungin, it seems likely that the prevalence of zygomycosis as a Breakthrough Infection may increase in the future. Zygomycosis is a rare, but life-threatening, deep fungal Infection that appears in immunologically or metabolically compromised hosts. Its manifestations are clinically similar to those of invasive aspergillosis. In addition to the well-established epidemiology of zygomycosis, this case suggests the following new characteristics. (1) Although the gastrointestinal manifestation of zygomycosis is relatively rare, it is observed more frequently than invasive aspergillosis. (2) Gastrointestinal zygomycosis occasionally leads to the development of necrotic ulcers and may induce hemorrhagic shock.(3) We should be cautious of an occurrence of Breakthrough zygomycosis when we use echinocandins for patients with known risk factors, especially steroid use and neutropenia. (4) For patients who are receiving broad-spectrum antibiotics and echinocandins, who are negative for culture studies and aspergillus antigen, and who present with unresolved fever, it is important to make a prompt clinical diagnosis of zygomycosis.
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Breakthrough cryptococcosis in a patient with systemic lupus erythematosus (SLE) receiving micafungin
Journal of Infection and Chemotherapy, 2008Co-Authors: Kei Suzuki, Kazunori Nakase, Yumiko Sugawara, Kazuko Ino, Takao Sekine, Naoyuki KatayamaAbstract:A 67-year-old woman with systemic lupus erythematosus (SLE) was admitted to our hospital because of lupus nephritis. Methylprednisolone minipulse therapy dramatically reduced her proteinuria; however; she then complained of general fatigue with low-grade fever. Radiological and culture studies revealed no infectious focus, but she was treated with meropenem and micafungin, considering her immunosuppressive state. Cytomegalovirus antigenemia was later determined and ganciclovir was added. She became afebrile, but complained of nausea and headache, and disorientation, without meningeal signs. Because a brain computed tomography (CT) scan showed no abnormality, we initially suspected some kind of drug interaction. Despite the discontinuation of all drugs, however, she still suffered from disturbance of consciousness. A lumbar puncture revealed yeast cells stained by India ink. A diagnosis of cryptococcal meningitis was confirmed. Though fluconazole and meropenem were administered, the patient died. Autopsy findings revealed disseminated cryptococcosis concomitant with pulmonary aspergillosis. Micafungin is a recently approved echinocandin-class antifungal agent that is now widely used in Japan because of its minimal toxicity and broadspectrum activity. However, such echinocandins have limited activity against a number of fungi. Indeed, Breakthrough trichosporonosis is becoming a significant problem in patients with hematological malignancies who are receiving echinocandins. To the best of our knowledge, Breakthrough cryptococcosis, as seen in our patient, has not been reported previously in patients who were receiving micafungin as an empiric antifungal therapy. This case highlights that cryptococcosis should be kept in mind as a possible Breakthrough Infection during the administration of echinocandins, especially in patients with cellular immunodeficiency.