Towards canine rabies elimination: Economic comparisons of three project sites

An appreciation of the costs of implementing canine rabies control in different settings is important for those planning new or expanded interventions. Here we compare the costs of three canine rabies control projects in South Africa, the Philippines and Tanzania to identify factors that influence the overall costs of rabies control efforts. There was considerable variation in the cost of vaccinating each dog, but across the sites these were lower where population density was higher, and later in the projects when dog vaccination coverage was increased. Transportation costs comprised a much higher proportion of total costs in rural areas and where house‐to‐house vaccination campaigns were necessary. The association between the cost of providing PEP and human population density was less clear. The presence of a pre‐existing national rabies management programme had a marked effect on keeping infrastructure and equipment costs for the project low. Finally, the proportion of the total costs of the project provided by the external donor was found to be low for the projects in the Philippines and South Africa, but likely covered close to the complete costs of the project in Tanzania. The detailed economic evaluation of three recent large‐scale rabies control pilot projects provides the opportunity to examine economic costs across these different settings and to identify factors influencing rabies control costs that could be applied to future projects.     

术后房颤危险因素的研究进展

术后房颤是一种常见的术后并发症,虽有一定自限性,但是会给患者带来严重的危害。术后房颤可能使患者继发心血管疾病、急性肾损伤、脑卒中,甚至死亡,增加患者医疗负担。术后房颤的早期预防在疾病发展环节中十分重要。本文收集了近年来关于术后房颤的研究文献,以详细阐述术后房颤危险因素的最新研究进展,为早期识别术后房颤高危患者提供理论支持,并通过分析围术期药物对术后房颤的影响,为围术期早期预防术后房颤提供参考。     

Method of venous thromboembolism prophylaxis is not a predictor of pulmonary embolus following elective bariatric surgery: a retrospective cohort study of 135,409 patients

BackgroundPatients with obesity are at increased risk of pulmonary embolus (PE), a risk that increases perioperatively and is challenging to manage.ObjectiveAn analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was performed to determine predictors of PE in patients undergoing elective bariatric surgery.SettingNorth American accredited bariatric surgery institutions included in the MBSAQIP database from 2020–2021.MethodsWe extracted data from the MBSAQIP database (2020–2021) on patients who underwent elective Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Data were extracted on patient co-morbidities, race, prior history of deep vein thrombosis (DVT), and type of DVT prophylaxis. A multivariate logistic regression model was developed to determine predictors of PE and impact of PE on 30-day serious complications and mortality.ResultsIn the MBSAQIP database, a total of 135,409 patients underwent SG or RYGB from 2020 to 2021. PE was reported in 194 patients (.14%). Prior history of DVT (odds ratio [OR] = 3.28; 95% confidence interval [CI]: 1.85–5.83; P < .0001), Black race (OR = 3.03; 95% CI: 2.22–4.13; P < .0001), gastroesophageal reflux disease (OR = 1.51; 95% CI: 1.11–2.04; P = .008), higher body mass index (OR = 1.11; 95% CI: 1.01–1.20; P = .023), male sex (OR = 1.76; 95% CI: 1.26–2.45; P = .001), and older age (OR = 1.27; 95% CI: 1.10–1.46; P = .001) were associated with increased odds of PE. Chronic obstructive pulmonary disease, sleep apnea, and hypertension were not significant predictors of PE (P > .05). Neither combined mechanical and pharmacologic DVT prophylaxis nor pharmacologic prophylaxis alone was a significant predictor of PE (P > .05).ConclusionPrior history of DVT is the strongest predictor of PE after bariatric surgery. African American race, male sex, and gastroesophageal reflux disease are additional risk factors. Method of venous thromboembolism prophylaxis was not identified as significant predictor of PE. Further, studies on the evaluation and optimization of venous thromboembolism prophylaxis are required.     

White paper on antimicrobial stewardship in solid organ transplant recipients

Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a “one-size-fits-all” style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.     

Management of patients with acute myeloid leukemia undergoing therapy with midostaurin: a focus on antifungal prophylaxis

Both therapy and prophylaxis for infectious complications during the treatment of acute myeloid leukemia (AML) have improved, although invasive fungal disease still remains a life‐threatening occurrence. Accordingly, prophylactic strategies with effective and well‐tolerated antifungals remain a cornerstone of management. Herein, the recent literature on antifungal prophylaxis used during the treatment of AML is reviewed, with a focus on the use in combination with midostaurin. The multikinase inhibitor midostaurin targets FMS‐like tyrosine kinase 3 (FLT3) and is approved, in association with 7 + 3, for the treatment of adult patients with newly diagnosed FLT3‐mutated AML. Midostaurin has been shown to extend both overall and event‐free survival in AML patients with an FLT3 mutation and is now the standard of care in FLT3+ AML. Antifungal prophylaxis should be adopted during all phases of treatment in all AML patients, and the strong CYP3A4 inhibitor posaconazole is frequently the preferred agent. As midostaurin is metabolized primarily by CYP3A4, there is a potential for drug–drug interactions that requires further evaluation. At present, the available data suggest that there are no absolute contraindications for coadministration of midostaurin with posaconazole, albeit with cautious monitoring. Considering the survival advantage offered by midostarin, concomitant administration of strong CYP3A4 inhibitors should not be ruled out, although such use should be evaluated cautiously and used on a case‐by‐case basis only if there are no suitable alternatives. It should also be kept in mind that patients with invasive fungal infection undergoing therapy for AML with midostaurin may need prolonged antifungal therapy, which must be based on the administration of the appropriate antifungal agent.     

Prophylactic corticosteroid use prevents engraftment syndrome in patients after autologous stem cell transplantation

Engraftment syndrome (ES) following autologous stem cell transplantation (ASCT) at the time of neutrophil recovery may comprise fever, rash, pulmonary edema, or diarrhea. Usually, ES is easily manageable using corticosteroids but may prolong hospitalization. In two consecutive cohorts of subsequent patients with myeloma, lymphomas, and testicular/germ cell cancer, we assessed the benefit of corticosteroid use to prevent incidence and severity of ES following ASCT. Whereas Cohort A (82 patients) received no prophylactic corticosteroids, corticosteroids (4 mg dexamethasone oral daily) were started in Cohort B (60 patients) at day +9 until day +13 following ASCT. Steroid prophylaxis significantly reduced the incidence of ES (6/60; 10% vs. 33/82; 40%; p < 0.001). Hospitalization duration was longer in patients with ES than in patients without ES within both cohorts (in Cohort A: p = 0.007; and B: p = 0.011), but did not differ significantly between cohorts A and B. Finally, in Cohort A, there was a trend to an inferior 2‐year overall survival rate in patients without ES compared to patients with ES (p = 0.067), but definite conclusions are not yet allowed. Our results suggest that corticosteroid prophylaxis from days +9 to +13 following ASCT significantly reduces the risk of ES and shortens hospitalization duration.