ABSTRACT
An increasingly asked question is 'can we confidently link bats with emerging viruses?'. No, or not yet, is the qualified answer based on the evidence available. Although more than 200 viruses - some of them deadly zoonotic viruses - have been isolated from or otherwise detected in bats, the supposed connections between bats, bat viruses and human diseases have been raised more on speculation than on evidence supporting their direct or indirect roles in the epidemiology of diseases (except for rabies). However, we are convinced that the evidence points in that direction and that at some point it will be proved that bats are competent hosts for at least a few zoonotic viruses. In this review, we cover aspects of bat biology, ecology and evolution that might be relevant in medical investigations and we provide a historical synthesis of some disease outbreaks causally linked to bats. We provide evolutionary-based hypotheses to tentatively explain the viral transmission route through mammalian intermediate hosts and to explain the geographic concentration of most outbreaks, but both are no more than speculations that still require formal assessment.
Subject(s)
Animals , Humans , Antineoplastic Agents, Phytogenic/isolation & purification , Antioxidants/isolation & purification , Fatty Acids/analysis , Industrial Waste/analysis , Malus/chemistry , Plant Oils/isolation & purification , Seeds/chemistry , Antineoplastic Agents, Phytogenic/adverse effects , Antineoplastic Agents, Phytogenic/economics , Antineoplastic Agents, Phytogenic/pharmacology , Antioxidants/adverse effects , Antioxidants/economics , Antioxidants/pharmacology , Cell Line, Tumor , Chemical Phenomena , CHO Cells , Cricetulus , Cell Proliferation/drug effects , Dietary Supplements/adverse effects , Dietary Supplements/economics , Fatty Acids, Nonesterified/adverse effects , Fatty Acids, Nonesterified/analysis , Fatty Acids, Nonesterified/economics , Fatty Acids/adverse effects , Fatty Acids/economics , Food Preservatives/adverse effects , Food Preservatives/economics , Food Preservatives/isolation & purification , Food Preservatives/pharmacology , Food-Processing Industry/economics , Fruit/chemistry , Fruit/economics , India , Industrial Waste/economics , Linoleic Acid/adverse effects , Linoleic Acid/analysis , Linoleic Acid/economics , Oleic Acid/adverse effects , Oleic Acid/analysis , Oleic Acid/economics , Plant Oils/chemistry , Plant Oils/economics , Plant Oils/pharmacologyABSTRACT
An economic evaluation of paclitaxel added subsequently to doxorubicin plus cyclophosphamide (AC) adjuvant therapy for early breast cancer with lymph nodes positive is presented. Health care cost associated with AC alone vs. AC with paclitaxel was compared under Thai health care context. Based on CALGB9344, paclitaxel increased the disease-free survival (DFS) by 17%. Based on Markov simulation for 15 years, paclitaxel prolonged the patient's life by 0.30 quality-adjusted life years (QALY). Such an increased effectiveness was offset by the adjuvant cost net of recurrence, follow-up, and terminal care by 221,433 Baht. This means an additional year of perfect health gained by paclitaxel is achieved through an incremental cost of 738,111 Baht. Such an incremental cost-effectiveness ratio (ICER) is beyond the threshold recommended by World Health Organization. In women with negative estrogen receptor that DFS was improved to 28%, the ICER of paclitaxel was reduced to 393,984 Baht per QALY.