BUDGET IMPACT ANALYSIS OF USING OMEPRAZOLE IMMEDIATE-RELEASE ORAL SUSPENSION IN REPLACE OF INTRAVENOUS PANTOPRAZOLE IN CRITICALLY ILL PATIENTS

OBJECTIVES

The aim of the present study was to estimate the financial consequence of using omeprazole immediate-release (IR) oral suspension versus pantoprazole intravenous infusion for preventing stress-related upper gastrointestinal bleeding in critically ill patients from the perspective of the health care system.

METHODS

An Excel-based model was developed to compare the cost of prevention of upper gastrointestinal bleeding early after intensive care admission using the current intravenous (IV) pantoprazole formulation versus omeprazole IR oral suspension. Total costs included the cost of acid suppressive drugs and related clinical outcomes. Inputs were obtained from a local clinical trial, the Ministry of Health database, insurance organizations, hospital and pharmacy registries, the relevant literature, and expert opinion. The robustness of the input data was investigated by one-way sensitivity analysis. The model was developed based on the results of a randomized control trial (RCT), in which experimental and control groups received omeprazole and pantoprazole, respectively.

RESULTS

According to the proposed model, the cost of gastrointestinal (GI) bleeding prevention using pantoprazole IV was US$ 950,000 while US$ 750,000 was spent on receiving omeprazole oral suspension. These costs led to the annual cost-saving of almost US$ 200,000 (US$4 per member, per month) for the health care system.

CONCLUSIONS

In the present study, a budget impact analysis was performed to assess the financial consequences of using omeprazole IR oral suspension in place of pantoprazole IV for prevention of upper gastrointestinal bleeding. The better preventive effect of omeprazole IR oral suspension when compared with conventional therapy using pantoprazole IV was the major reason for the final comparative budgetary savings.

Falls and postural control in older adults with cataracts

BACKGROUND

There is increasing evidence that visual impairment contribute to falling. The aim of this study was to determine the influence of vision impairment of old adult patients with cataract on the occurrence of falls and postural control.

METHODS

According to the results of screening ophthalmic examination, 48 cataract patients (mean±SD aged 68.5 ± 6.08 yrs.) and 50 individuals without any obvious eye disorders (mean age ± SD 70.7 ± 5.97 yrs.) were enrolled in this study. The postural control was determined using the clinical test of Sensory Interaction and Balance (CTSIB) and Timed up and Go (TUG) test.

RESULTS

The results of this study revealed that 18% (n = 9) of the normal individuals and 22.9% (n =11) of the cataract patients had at least two falls in the past 12 months. However, the result of chisquare test did not show any differences between the two groups (p= 0.36). The mean ± SD TUG times in cataract and control groups in our study were15.17 ± 3.58 and13.77 ± 4.90, respectively. However, no significant differences were found between the two groups (p= 0.12).The results of CTSIB test showed no significant differences between the two groups on standing on the floor with eyes open and eyes closed (p= 0.61, p= 0.89) and on standing on the foam with eyes open and eyes closed (p= 0.32, p= 0.74 ).

CONCLUSION

According to the results of CTSIB and TUG tests, vision impairment of old adult patients with cataract is not associated with falls and balance disorders. Further work including assessment of postural control with advanced devices and considering other falls risk factors are also required to identify predictors of falls in cataract patients.

Ileal J-Pouch Perforation: Case Report

A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.

Biodegradation of naphthalene using Pseudomonas aeruginosa by up flow anoxic-aerobic continuous flow combined bioreactor

BACKGROUND

Naphthalene is a poly aromatic hydrocarbon (PAH) present in many sediment-water systems. The aim of this study was to evaluate the applicability of an anoxic/aerobic system for the biological treatment of water polluted by naphthalene by Pseudomonas aeruginosa PTCC 1707 to utilize naphthalene. The naphthalene elimination from wastewater was determined in anoxic-aerobic continuous flow combined bioreactor under continuously oxic and anoxic conditions. Experiments were conducted in continues mode, and naphthalene was administered in consecutive spike doses. Then Pseudomonas aeruginosa bacteria suspension with a specific turbidity (0.5-10 NTU) was prepared from growing bacteria on R2A medium and injected to reactor.

FINDINGS

At naphthalene concentration = 0.5-20 mg/L, 33-65.5% naphthalene removal efficiencies were observed. Mean COD removal efficiency in solid retention times of 2, 4, 6, and 8 days was 82.7, 92.45, 95.97 and 96.1%, respectively. Naphthalene removal efficiency by bacterium pseudomonas at pH 8 was 96% and at pH 4, 5.5, 7 and 9.5, 68, 80, 90 and 85%, respectively. As the initial concentration of naphthalene increased from 0.5 to 20 mg/L, the remaining concentration of naphthalene decreased from 33.4% to 65.5% after 3 days.

CONCLUSION

Based on experimental results, it was determined that this process can effectively reduce naphthalene under optimal conditions and this method can be used for the removal of similar compounds.

Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) one expulsive anger and impulsive behaviors

INTRODUCTION

The purpose of this study is to measure Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) on Expulsive Anger and Impulsive Behaviors.

MATERIALS & METHODS

Research method is a semi experimental socio-statistic approach consisting of experimental group (dialectical behavior therapy) and control group. Participants were patients referred to Amir Kabir Hospital in Arak who suffered from Expulsive Anger and Impulsive Behaviors. Based on stratified random sampling, 16 patients (women) were placed in each group. Research tools included the structured diagnosis interview according to DSM-IV-TR (2000), Barrat impulsivity scale(1994) Distress Tolerance Scale (2005) Difficulties of Emotion Regulation Scale (2004) and dialectical behavior therapy were done for two months,8 group-sessions).

FINDINGS

Dialectical behavior therapy was effective on Expulsive Anger and Impulsive Behaviors.

DISCUSSION & CONCLUSION

Distress tolerance and emotion regulation components were effective on Expulsive Anger and Impulsive Behaviors.

Increasing the number of adverse drug reactions reporting: the role of clinical pharmacy residents

Detection of adverse drug reactions (ADRs) in hospitals provides an important measure of the burden of drug related morbidity on the healthcare system. Spontaneous reporting of ADRs is scare and several obstacles to such reporting have been identified formerly. This study aimed to determine the role of clinical pharmacy residents in ADR reporting within a hospital setting. Clinical pharmacy residents were trained to report all suspected ADRs through ADR-reporting yellow cards. The incidence, pattern, seriousness, and preventability of the reported ADRs were analyzed. During the period of 12 months, for 8559 patients, 202 ADR reports were received. The most frequently reported reactions were due to anti-infective agents (38.38%). Rifampin accounted for the highest number of the reported ADRs among anti-infective agents. The gastro-intestinal system was the most frequently affected system (21.56%) of all reactions. Fifty four of the ADRs were reported as serious reactions. Eighteen of the ADRs were classified as preventable. Clinical pharmacy residents' involvement in the ADR reporting program could improve the ADR reporting system.

Evaluation of Zataria MultiFlora Boiss and Carum copticum antibacterial activity on IMP-type metallo-beta-lactamase-producing Pseudomonas aeruginosa

Carbapenem resistance due to acquired metallo-beta-lactamases (MBLs) is considered to be more serious than other resistance mechanisms. The aim of this study was to evaluate the antibacterial activity of Zataria multiflora Boiss and Carum copticum plants on IMP-producing P.aeruginosa strains. This experimental study was carried out on hospitalized burn patients during 2011 and 2012. Antibiotics and extracts susceptibility tests were performed by disc diffusion and broth microdilution methods. MBL detection was performed by Combination Disk Diffusion Test (CDDT). The bla(VIM) and bla(IMP) genes were detected by PCR and sequencing methods. Using Combination Disk Diffusion test method, it was found that among 83 imipenem resistant P.aeruginosa strains, 48 (57.9%) were MBL producers. PCR and sequencing methods proved that these isolates were positive for blaIMP-1 genes, whereas none were positive for bla(VIM) genes. The mortality rate of hospitalized patients with MBL-producing Pseudomonas infection was 4/48 (8.3%). It was shown that Zataria multiflora and Carum copticum extracts had a high antibacterial effect on regular and IMP-producing P. aeruginosa strains in 6.25 mg/ml concentration. The incidence of MBL-producing P. aeruginosa in burn patients is very high. In our study, all MBL-producing isolates carry the blaIMP-1 gene. Therefore, detection of MBL-producing isolates is of great importance in identifying drug resistance patterns in P. aeruginosa, and in prevention and control of infections. In this study, it was shown that extracts of Z. multiflora and C. copticum have high antibacterial effects on ß-lactamase producing P. aeruginosa strains.

Delayed capillary breakup of falling viscous jets

Thin jets of viscous fluid like honey falling from capillary nozzles can attain lengths exceeding 10 m before breaking up into droplets via the Rayleigh-Plateau (surface tension) instability. Using a combination of laboratory experiments and WKB analysis of the growth of shape perturbations on a jet being stretched by gravity, we determine how the jet's intact length l(b) depends on the flow rate Q, the viscosity η, and the surface tension coefficient γ. In the asymptotic limit of a high-viscosity jet, l(b)∼(gQ(2)η(4)/γ(4))(1/3), where g is the gravitational acceleration. The agreement between theory and experiment is good, except for very long jets.

A linear, time-invariant model for cancerous and normal breast tissue

Electrical properties of biological cells and human tissue have been used to characterize cancerous vs. normal tissue. Commonly, measured dielectric spectra (permittivity and conductivity) are fitted into an empirical function and the best-fit parameters of the function are considered as a tool to differentiate various types of tissue; however, these parameters do not provide any explanation for the underlying molecular structure. In this work, we modeled the frequency dependence of impedance data collected from human breast tissue using a high-order, linear, time-invariant filter. The results show that the parameters of the filter not only can be used to classify tissue types, they may provide meaningful information about the properties and structure of tissues.

Cloning of fimH and fliC and expression of the fusion protein FimH/FliC from Uropathogenic Escherichia coli (UPEC) isolated in Iran

BACKGROUND AND OBJECTIVES

Urinary tract infection (UTI) is one of the most common infections in the world. The majority of UTIs are caused by Uropathogenic Escherichia coli (UPEC) strains. FimH and FliC are the most important virulence factors of UPEC. To date, any ideal vaccine against UTI has not been approved for human use and we need to test new targets to develop an ideal vaccine against UTI. In this study, we constructed fusion fimH/fliC of UPEC as a novel vaccine candidate against UTI.

MATERIAL AND METHODS

PCR amplification of fimH and fliC genes of the UPEC isolates was performed by specific primers designed for this purpose. Construction of fimH/fliC hybrid gene was performed by overlap PCR. The fimH, fliC and fimH/fliC were cloned in pET28a vector. The confirmation of expression of the proteins was done by SDS-PAGE and Western blot.

RESULTS

The fliC and fimH genes were amplified in all of the UPEC isolates tested. The fimH showed significant homology with the sequences in GenBank. We generated a fusion consisting of the fimH linked to the N-terminal end of fliC. Sequencing of the fusion fimH/fliC showed that fusion was constructed correctly. SDS-PAGE and western blot confirmed the expression of the proteins in optimized condition.

CONCLUSION

Urinary tract infection is a huge burden on healthcare system in many countries. UPEC is isolated in around 80% of UTI cases. Antibiotic therapy resulted in the emergence of antibiotic resistance in UPEC strains. This is the major cause for an increasing requirement for a vaccine to prevent UTI. This work describes for the first time the construction of a novel fusion protein from Iranian UPEC isolates. Further immunological studies are required for evaluation of this protein as a novel and safe vaccine candidate against UTI caused by UPEC.

The study of effectiveness of blended learning approach for medical training courses

BACKGROUND

Blended learning as a method of learning that includes face to face learning, pure E-learning and didactic learning. This study aims to investigate the efficacy of medical education by this approach.

METHODS

This interventional study was performed in 130 students at different clinical levels participating in class sessions on "congenital adrenal hyperplasia and ambiguous genitalia". Sampling was done gradually during 6 months and all of them filled a pretest questionnaire and received an educational compact disk. One week later, a presence class session was held in a question and answer and problem solving method. Two to four weeks later, they filled a posttest questionnaire.

RESULTS

There was a significant correlation between pretest and posttest scores and the posttest scores were significantly more than the pretest ones. Sub-specialized residents had the most and the students had the least attitude towards blended learning approach. There was a significant correlation between the research samples' accessibility to computer and their attitude and satisfaction to blended learning approach.

CONCLUSION

Findings generally showed that the blended learning was an effective approach in making a profound learning of academic subjects.