RESUMEN
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.
Asunto(s)
Animales , Humanos , Antineoplásicos Fitogénicos/aislamiento & purificación , Antioxidantes/aislamiento & purificación , Ácidos Grasos/análisis , Residuos Industriales/análisis , Malus/química , Aceites de Plantas/aislamiento & purificación , Semillas/química , Antineoplásicos Fitogénicos/efectos adversos , Antineoplásicos Fitogénicos/economía , Antineoplásicos Fitogénicos/farmacología , Antioxidantes/efectos adversos , Antioxidantes/economía , Antioxidantes/farmacología , Línea Celular Tumoral , Fenómenos Químicos , Células CHO , Cricetulus , Proliferación Celular/efectos de los fármacos , Suplementos Dietéticos/efectos adversos , Suplementos Dietéticos/economía , Ácidos Grasos no Esterificados/efectos adversos , Ácidos Grasos no Esterificados/análisis , Ácidos Grasos no Esterificados/economía , Ácidos Grasos/efectos adversos , Ácidos Grasos/economía , Conservantes de Alimentos/efectos adversos , Conservantes de Alimentos/economía , Conservantes de Alimentos/aislamiento & purificación , Conservantes de Alimentos/farmacología , Industria de Procesamiento de Alimentos/economía , Frutas/química , Frutas/economía , India , Residuos Industriales/economía , Ácido Linoleico/efectos adversos , Ácido Linoleico/análisis , Ácido Linoleico/economía , Ácido Oléico/efectos adversos , Ácido Oléico/análisis , Ácido Oléico/economía , Aceites de Plantas/química , Aceites de Plantas/economía , Aceites de Plantas/farmacologíaRESUMEN
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.