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P Leal

Publications and source records attributed to P Leal.

4 recordsLinked to original sources
PubMed1999

What is the cost utility of screening for hepatitis C virus (HCV) in intravenous drug users?

OBJECTIVES: To model the likely cost utility of the prevalence round of a screening programme for hepatitis C (HCV) in intravenous drug users (IVDUs) in contact with services in the South and West health region of the UK. METHODS: Information on the prevalence of HCV, performance of diagnostic tests, and effectiveness of interferon alpha (IFN alpha) for treatment of chronic hepatitis were brought together with estimates of the costs of service provision. A simple spreadsheet model was used to estimate cost utility (cost/quality adjusted life year (QALY)). Assumptions (including use of ribavirin plus IFN alpha combination therapy) were tested by a one way sensitivity analysis. RESULTS: About 5600 IVDUs live in the region. A combination of enzyme linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) testing has high sensitivity and specificity for detecting HCV. There is excellent evidence that IFN alpha is effective in producing sustained normalisation of liver function and, by inference, eradicating HCV. Evidence for long term benefits comes from modelling studies based on progression of HBV or non-A, non-B hepatitis and is considerably less robust. The cost of the prevalence round of screening in IVDUs would be about 700,000 Pounds and is likely to identify about 1400 people, of whom about 270 would be eligible for treatment and 20 would respond to IFN alpha. This gives a cost/QALY of 9300 Pounds for the screening programme. However, much uncertainty around the estimates used to inform the cost utility calculation limits confidence in the value of screening IVDUs for HCV. Sensitivity analysis shows a range of possible cost utility from 3333 Pounds to 81,438 Pounds. Estimates are particularly sensitive to adherence to liver biopsy and treatment and to discounting of benefits. CONCLUSIONS: Although potentially cost effective, many important uncertainties surround the assumptions used to estimate the long term effectiveness of screening and treatment. There is insufficient evidence to inform policy development and further research is required in this rapidly changing field.

Comorbidity↗
PubMed1981

Bottled mineral waters polluted by protozoa in Mexico.

A survey of protozoa polluting bottled mineral water in Mexico was carried out using samples obtained form the three best-selling brands of bottled mineral water in the country. The organisms were concentrated through filtration procedures and subsequently cultured in the sterile media. The cultures were observed over four weeks, with identification to the level of genus and species. Most commonly found were the amoebae Naegleria gruberi, Acanthamoeba astronyxis, and Vahlkampfia vahlkampfi (trophic as well as cystic stages) plus one flagellate, Bodomorpha minima. No ciliates were detected. The public health importance of the findings is obvious, since some strains of Naegleria and Acanthamoeba have the potential to cause human disease that may lead to death.

Amoeba↗
PubMed1975

Infusion tomography of the gallbladder.

Infusion tomography of the gallbladder has proved to be more specific in the detection of pathologic disease as compared with conventional roentgenologic examinations by showing the wall of the organ instead of the contents. Infusion tomography of the gallbladder has been a useful initial procedure in patients with acute cholecystitis and in those with obstructive jaundice. It has helped to confirm diagnosis in patients with chronic lithiasic cholecystitis and nonvisualized gallbladder or with gallstones with documented on oral or intravenous studies. Infusion tomography of the gallbladder can be done on an emergency basis; it requires no prior preparation of the patient and usually yields an answer within 30 minutes. No significant complications have resulted from the high dose of iodized contrast material. There have been only two false results, one negative and one positive, so the procedure can be regarded as a highly reliable one.

Adult↗