Association of ficolin-2 gene polymorphisms and susceptibility to systemic lupus erythematosus in Egyptian children and adolescents: a multicenter study.

BACKGROUND: Pediatric-onset SLE (pSLE) is a multisystem autoimmune disease. Recently, the ficolin-2 (FCN2) gene has emerged as a potential candidate gene for susceptibility to SLE. OBJECTIVES: The objective of this study was to evaluate the association of the FCN2 gene polymorphisms at positions -986 (G/A), -602 (G/A), -4 (A/G) and SNP C/T (rs3124954) located in intron 1, with susceptibility to pSLE in Egyptian children and adolescents. METHODS: This was a multicenter study of 280 patients diagnosed with pSLE, and 280 well-matched healthy controls. The FCN2 promoter polymorphisms at -986 G/A (rs3124952), -602 G/A (rs3124953), -4 A/G (rs17514136) and SNP C/T (rs3124954) located in intron 1 were genotyped by polymerase chain reaction, while serum ficolin-2 levels were assessed using enzyme-linked immunosorbent assay. RESULTS: The frequencies of the FCN2 GG genotype and G allele at -986 and -602 positions were significantly more represented in patients with pSLE than in controls (p < 0.001). Conversely, the FCN2 AA genotype and A allele at position -4 were more common in patients than in controls (p < 0.001). Moreover, patients carrying the FCN2 GG genotype in -986 position were more likely to develop lupus nephritis (odds ratio: 2.6 (95% confidence interval: 1.4-4.78); p = 0.006). The FCN2 AA genotype at position -4 was also identified as a possible risk factor for lupus nephritis (odds ratio: 3.12 (95% confidence interval: 1.25-7.84); p = 0.024). CONCLUSION: The FCN2 promoter polymorphisms may contribute to susceptibility to pSLE in Egyptian children and adolescents. Moreover, the FCN2 GG genotype at position -986 and AA genotype at position -4 were associated with low serum ficolin-2 levels and may constitute risk factors for lupus nephritis in pSLE.

Arthroscopically assisted ACL reconstruction using central third patellar tendon autograft with press fit femoral fixation.

The ACL is a complex structure, and its replacement involves precise surgical technique, which relates directly to its function in constraining anterior tibial translation. Many techniques have been developed for reconstruction of the ACL. Here we have described our method of choice for arthroscopically assisted graft placement, which uses the middle-third patellar tendon autograft placed using a press-fit fixation technique. This technique was developed to avoid drawbacks encountered with fixation using an interference screw. Biomechanical testing has shown this technique to be similar in pull-out strength to fixation obtained with an interference screw, but without the associated technical difficulties. One other benefit of this technique, which is not readily apparent, and not one that we, as surgeons, would ever hope to take advantage of, is that should a revision ACL reconstruction be necessary in the future, there is no interference screw in the femur to remove.

Assessing cost effectiveness of antimicrobial treatment: monotherapy compared with combination therapy.

The obvious costs of antibiotic treatment include drugs, equipment with which to give them, and assays. Less obvious, but more important, are the costs of quality control to ensure safe and effective treatment. The more complex the regimen, the more expensive the quality control. None the less, there is considerable variation in both assay price and number of assays/patient. Our data show that the drug costs of a regimen such as ampicillin plus gentamicin plus metronidazole are outweighed by the costs of quality assurance to prevent drug toxicity and charges of malpractice. Trials show that monotherapy with various beta-lactams is more cost effective than aminoglycoside combinations for surgical infections. Compounds such as piperacillin/tazobactam, a new beta-lactam/beta-lactamase inhibitor combination that is classed as monotherapy, have the potential to solve many of these economic problems. Several completed and continuing clinical studies are showing that monotherapy is as effective as combination treatment. Cost studies in the future are likely to confirm the economic advantages of monotherapy.

Cost of gentamicin assays carried out by microbiology laboratories.

AIMS: To assess the current range of prices charged for gentamicin assays in United Kingdom laboratories; and to examine the laboratories' likely response to increases or decreases in the demand for the service. METHODS: A postal survey of the 420 members of the Association of Medical Microbiologists was used to establish the range of prices charged for aminoglycoside assays. Additionally, eight private institutions were contacted to determine what the private sector was charging for aminoglycoside assays. Reagent costs in the NHS laboratories were calculated by dividing the total cost of all aminoglycoside assay kits by the number of samples analysed. RESULTS: The NHS and the private institutions both showed a wide price variation. Prices charged to an in-hospital requester for a peak and trough assay ranged from 5.00 pounds to 68.20 pounds (n = 44), and to an external private hospital, under a bulk service contract, from 5.00 pounds to 96.00 pounds (n = 47). Prices charged by private laboratories ranged from 49.00 pounds to 84.00 pounds (n = 8). There was a log linear correlation in the NHS laboratories between the reagent costs per assay and the number of assays performed per year, and most laboratories thought that their price per assay would be sensitive to increases or decreases in demand. Laboratories which had purchased their assay machines had lower reagent costs per assay but higher repair and maintenance costs. Overall, number of assays performed and method of payment for assay machinery only accounted for 44.8% of the observed variation in assay kit costs. CONCLUSIONS: The price range for gentamicin assays in the United Kingdom is wide and is only partially explained by the number of assays performed. Most laboratories believe that they would experience a reduction in unit cost as output increases. The currently offered range of prices is, in part, due to variation in the laboratories' approach to costing the service provided and some laboratories charge prices which do not even cover the cost of assay kits. Overall, we believe that prices charged should be as close as possible to the marginal cost of the tests performed.

Pharmacoeconomics of antimicrobial prophylaxis.

Pharmacoeconomic analysis of the prevention of infection is based on quantification of the benefits which result from prevention, rather than simple counting of the number of cases prevented. In general, benefits are best quantified as continuous variables which measure severity as well as occurrence, for example, cost of antibiotics prescribed is a useful continuous measure of severity to add to a discontinuous measure, such as number of patients who received antibiotics. Considerable progress has been made in the USA with the application of decision analysis to clarify the options available for dealing with a problem, the probability of good and bad outcomes for each choice and the utility which is associated with each outcome. These techniques deserve wide application. Much existing practice is based on limited, poor quality information about the occurrence and severity of infection. This situation can only be improved by wider application of standardized methods for definition of occurrence of infection and of underlying risk of infection.

Pharmacoeconomics of antibacterial treatment.

Antibacterial drugs account for between 3 and 25% of all prescriptions, between 6 and 21% of the total market value of drugs in a single country, and up to 50% of the drug budget in hospitals. Bacterial infection is widely perceived as disease caused by harmful outside agents which can be isolated and tested to select the best drug for treatment. In fact, the need for any treatment and the pros and cons of different drugs are just as debatable as in any other therapeutic area. Moreover, the bacteria which make up the normal flora of the body fulfil important roles, so that the ecological implications of treatment for the individual and for society should be considered in assessing the costs and consequences of antibacterial treatment. In this review we outline the most important issues relating to the treatment of bacterial infection in the community and in the hospital, contrasting information from developed and developing countries where appropriate. We review the existing literature on economic evaluation, but in general most of the literature deals with containing the costs of antibacterial drugs in hospitals, and there are many gaps in the literature on cost-effectiveness of treatment. Consequently there are still extreme variations in medical practice which present a challenge for future evaluation. As the outcomes of antibacterial treatment are apparent in a few weeks or months, this is an ideal field for testing pharmacoeconomic methodology. The desire to overcome medical practice variation through consensus statements should be avoided. Instead we recommend wider application of decision analysis to acknowledge that choices exist for the diagnosis and treatment of bacterial infection and to gather information about the implications of these choices. Much of the existing literature would be improved by a more explicit definition of costs. Direct costs to the health services should be distinguished from non medical costs. Moreover, the analysis should consider whether savings from one budget result in costs to another health service budget, or to the patient (transfer costs). These deficiencies in cost analysis will be relatively easy to correct. Of more concern is the fact that the efficacy of much antibacterial treatment is either totally debatable, or variable, depending on factors such as the type of patient treated or the quality of delivery of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Patellofemoral pain. An arthroscopic perspective.

Patellofemoral pain should be approached as thoroughly as any other musculoskeletal disease. A careful patient history and physical examination are mandatory. These are followed by appropriate imaging studies such as radiographs, bone scans, CT scans, CT arthrograms, and MRI, as each individual case demands. Finally, arthroscopy is employed in its proper sequence. This article has been developed as an attempt to define a classification scheme of anterior knee pain and then to narrow this down to pain localized to the patellofemoral joint. The authors have attempted to isolate further the clinical entities to those that can be diagnosed and treated arthroscopically. Arthroscopy and arthroscopic surgery allow recognition and treatment of these disorders with minimal invasiveness and patient morbidity.

Postoperative wound scoring.

Assessing postoperative wound sepsis rates is important from both an economic and an audit point of view. Most definitions of wound sepsis are too narrow and too subjective and wound scoring systems that have been developed to counteract these deficiencies suffer from a lack of objectivity, making valid comparisons between wound sepsis rates in different institutions impossible. The ASEPSIS scoring system is a definite advance in this area and its proven reproducibility makes it invaluable in multicentre trials assessing wound sepsis. However, it has limitations, mainly associated with the underlying assumption regarding the linearity of the ASEPSIS index. It is felt that by closely examining ASEPSIS wound scores from a large number of patients it may be possible to improve this scoring system.

Patellofemoral pain syndromes: a comprehensive and conservative approach.

Among 7,785 patients examined with knee problems, 370 were diagnosed with patellofemoral pain syndromes. Examination and treatment were performed using a systematic approach. The patients were placed on a conservative program consisting of a four-stage progression, with the goal of relieving symptoms and returning to full activity. The results of this approach showed that 77% recovered. to a satisfactory level and 23% were unsatisfactory and underwent surgical procedures. J Orthop Sports Phys Ther 1981;2(3):108-116.