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The immunogenicity of fractional (one-fifth, 0.1 mL) intradermal doses of the inactivated poliovirus vaccine (ID fIPV) is positively correlated with the size of the intradermal fluid bleb. Training of vaccinators for campaign and routine ID fIPV administration should focus on generating an 8- to 10-mm bleb with each injection. Clinical Trials Registration NCT01847872.

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Rabies is a viral zoonosis affecting around 16,000-39,000 people annually. Pre-exposure vaccination should be offered to individuals at high risk of rabies exposure and is suggested for children living in rabies endemic areas.The incidence rate of dog bite in the test group was 14.1/1,000 person-years. Intradermal (ID) route of administration is considered an alternative to the standard intramuscular (IM) administration, and reduces vaccination cost. A 3-year clinical study of a rabies vaccine administered IM or ID to 12­18-month-old Thai children, simultaneously with a Japanese encephalitis (JE) vaccine (M49P2 study), revealed that all regimens used elicited an adequate immune response. In order to determine the long-term (4-8 years) rabies neutralizing antibody titers induced by the pre-exposure regimens, blood was collected annually from 68 from the M49P2 study and analyzed using a rapid fluorescence focus inhibition test. Full- IM(three doses of 1 ml/dose), half-IM(three doses of 0.5 ml/dose), and 3-ID(three doses of 0.1 ml/dose) regimens induced antibody titers above the seroprotective level throughout the study period. However, the 2-ID(two doses of 0.1 ml/dose) group had sub-seroprotective titer of 6.7%, 13.4%, 25.0%, and 36.4% in year 5, 6, 7, and 8, respectively. A secondary immune response was induced by rabies booster vaccination. This study demonstrates a reduced-dose rabies regimen may lower the cost of long-term protection against rabies for vulnerable populations, thus improving the cost-effectiveness of pre-exposure rabies vaccination in children.

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BACKGROUND: Peristomal hyperhidrosis can interfere with pouch adherence, resulting in pouch leakage and peristomal skin damage. CASE: A patient with autonomic dysregulation resulting in excessive sweating (hyperhidrosis) experienced difficulty with adherence of her ileostomy appliance. Two hundred units of botulinum toxin A (BTX-A) were injected in the dermis of the surrounding skin in order to improve adherence of her pouching system and alleviate moisture of her peristomal skin. RESULTS: Following BTX-A injection, the typical wear time of her pouching system improved from less than 24 hours to 120 hours. Peristomal moisture-associated skin damage resolved almost completely. These effects lasted 3 months. A repeat intradermal BTX-A injection had a similar positive effect. CONCLUSION: Peristomal hyperhidrosis can be controlled with BTX-A intradermal injections, improving patient pouch adherence and alleviating moisture-associated skin damage.

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Drug delivery requires precise intradermal and subcutaneous injections of formulations to clinically relevant penetration depths. However, penetration depth is confounded by skin deflection, which occurs prior to and during penetration as the skin surface deforms axially with the needle, and which varies profoundly due to differing intrinsic mechanical (e.g. viscoelastic) tissue properties, disease state, aging, and ethnicity. Herein, an ex vivo model was utilized to study factors that affect skin deflection and the efficacy of injection, including prestress applied at the tissue surface, needle gauge, velocity, and actuation depth. The application of prestress minimized skin deflection during needle penetration and allowed for needle actuation to the targeted penetration depths with minimum variability. The force required to achieve target penetration depths was found to increase with prestress and decrease with needle gauge. Our findings emphasize the need for prestress applied to the skin surface to minimize variation in skin properties and administer formulations for intradermal and subcutaneous treatments with maximum precision.

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OBJECTIVE: Lateral epicondylitis is a common complaint, with an annual incidence between 1% and 3% in the general population. The Dutch College of General Practitioners in The Netherlands has issued guidelines that recommend a wait-and-see policy. However, these guidelines are not evidence based. DESIGN AND SETTING: This paper presents the results of an economic evaluation in conjunction with a randomised controlled trial to evaluate the effects of three interventions in primary care for patients with lateral epicondylitis. PATIENTS AND INTERVENTIONS: Patients with pain at the lateral side of the elbow were randomised to one of three interventions: a wait-and-see policy, corticosteroid injections or physiotherapy. MAIN OUTCOME MEASURES AND RESULTS: Clinical outcomes included general improvement, pain during the day, elbow disability and QOL. The economic evaluation was conducted from a societal perspective. Direct and indirect costs (in 1999 values) were measured by means of cost diaries over a period of 12 months. Differences in mean costs between groups were evaluated by applying non-parametric bootstrap techniques. The mean total costs per patient for corticosteroid injections were euro430, compared with euro631 for the wait-and-see policy and euro921 for physiotherapy. After 12 months, the success rate in the physiotherapy group (91%) was significantly higher than in the injection group (69%), but only slightly higher than in the wait-and-see group (83%). The differences in costs and effects showed no dominance for any of the three groups. The incremental cost-utility ratios were (approximately): euro7000 per utility gain for the wait-and-see policy versus corticosteroid injections; euro12000 per utility gain for physiotherapy versus corticosteroid injections, and euro34500 for physiotherapy versus the wait-and-see policy. CONCLUSIONS: The results of this economic evaluation provided no reason to update or amend the Dutch guidelines for GPs, which recommend a wait-and-see policy for patients with lateral epicondylitis.

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El propósito de este estudio fue determinar si la lanceta bifurcada y el cilindro de multipunción son instrumentos adecuados para administrar vacunas antisarampionosas. Niños de 9 a 11 meses de edad de Sao Paulo, Brasil, recibieron la vacuna antisarampionosa Biken-Cam 70 (5 000 DICT 50/0,5ml) o la vacuna antisarampionosa Edmonston-Zagreb (7 000 DICT 50/0,5ml) por vía intradérmica, mediante una lanceta bifurcada o un cilindro de miltipunción. Estos instrumentos por lo general se usan para administrar la vacuna antivariólica o la BCG. El volumen de vacuna inoculado fue de aproximadamente 0,003 ml. Se determinaron los anticuerpos IgG contra el sarampión con la prueba de inmunoabsorción enzimática (ELISA) en el momento de la vacunación y ocho semanas después. Los participantes en el estudio fueron examinados 14 días después de la inoculación para detectar posibles reacciones adversas. En el momento de la vacunación la edad de los niños fue de 9,5+ 0,66 meses (media + desviación estándar). Ninguno de los 45 receptores de la vacuna Biken-Cam presentó respuesta serológica. En los 49 receptores de la vacuna Edmonston-Zagreb inmunizados con el cilindro de multipunción la tasa de respuesta serológica (35 por ciento) y la concentración media de anticuerpos contra el sarampión (323 mUI/ml) fueron algo mayores a las observadas en los 51 niños que recibieron la misma vacuna administrada con la lanceta bifurcada (26 por ciento y 291 mUI/ml, respectivamente). La tasa de síntomas informados después de la vacunación no difirió de manera significativa entre los grupos. En conjunto, la baja tasa de respuesta serológica tras la inmunización intradérmica con los instrumentos ensayados en este estudio indica que esta vía de administración no es adecuada para la administración ordinaria de vacunas de concentraciones estándar

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