Genetic testing in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cost-effectiveness analysis

BACKGROUND

The CYP2C19 genotype is a predictor of adverse cardiovascular events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) treated with clopidogrel.

OBJECTIVES

We aimed to evaluate the cost-effectiveness of a CYP2C19*2 genotype-guided strategy of antiplatelet therapy in ACS patients undergoing PCI, compared with two 'no testing' strategies (empiric clopidogrel or prasugrel).

METHODS

We developed a Markov model to compare three strategies. The model captured adverse cardiovascular events and antiplatelet-related complications. Costs were expressed in 2010 US dollars and estimated using diagnosis-related group codes and Medicare reimbursement rates. The net wholesale price for prasugrel was estimated as $5.45 per day. A generic estimate for clopidogrel of $1.00 per day was used and genetic testing was assumed to cost $500.

RESULTS

Base case analyses demonstrated little difference between treatment strategies. The genetic testing-guided strategy yielded the most QALYs and was the least costly. Over 15 months, total costs were $18 lower with a gain of 0.004 QALY in the genotype-guided strategy compared with empiric clopidogrel, and $899 lower with a gain of 0.0005 QALY compared with empiric prasugrel. The strongest predictor of the preferred strategy was the relative risk of thrombotic events in carriers compared with wild-type individuals treated with clopidogrel. Above a 47% increased risk, a genotype-guided strategy was the dominant strategy. Above a clopidogrel cost of $3.96 per day, genetic testing was no longer dominant but remained cost-effective.

CONCLUSIONS

Among ACS patients undergoing PCI, a genotype-guided strategy yields similar outcomes to empiric approaches to treatment, but is marginally less costly and more effective.

OA01.11. Toxicity study and testicular regeneration property of swarna vanga

Purpose:

Method:

Result:

Conclusion:

Health-care seeking among people with cough of 2 weeks or more in India. Is passive TB case finding sufficient?

SETTING

Thirty districts of India.

OBJECTIVES

To estimate 1) the proportion of people with cough of ≥2 weeks, 2) those who did not seek care from a health care provider for cough, and 3) their characteristics.

METHODOLOGY

A cross-sectional community-based survey in which 4562 people (aged ≥18 years) were interviewed.

RESULTS

Of the 4562 individuals interviewed, 437 (9.5%, 95%CI 7.2-11.8) had cough ≥2 weeks; this was more frequent in those >55 years of age (14%) and in those from districts in eastern (12%) and northern (11%) states of India. Of those with cough, 300 (69%, 95%CI 60-77) had not sought care from any health care provider. Not seeking care was more frequent in people residing in rural areas (73%) compared with urban areas (53%), and in the districts of eastern (82%) and northern (74%) states compared to districts from the southern (46%) and western (54%) states.

CONCLUSIONS

Nearly a tenth of those interviewed aged ≥18 years had cough of ≥2 weeks. About two thirds, especially those from rural areas, had not visited a health care provider for the cough. This finding has huge implications for India's current mostly passive case-finding strategy for detecting and controlling tuberculosis.

Carrier density dependence of the nonlinear absorption of intense THz radiation in GaAs

We study the carrier density dependence of nonlinear terahertz (THz) absorption due to field-induced intervalley scattering in photoexcited GaAs using the optical-pump/THz-probe technique. The intervalley scattering in GaAs is strongly dependent on the photo-carrier density. As the carrier density is increased from 1 × 10(17) to 4.7 × 10(17) cm(-3), the nonlinear absorption bleaching increases. However, if the carrier density is increased further above 4.7 × 10(17) cm(-3), the trend reverses and the bleaching is reduced. The initial increase in absorption bleaching is because, unlike low THz field, high THz field experiences intervalley scattering and nonparabolicity of the conduction band. On the other hand, a simple electron transport model shows that the reduction in intervalley scattering is mainly due to the increase in the electron-hole scattering rate with the increase in the carrier density. This increase in the electron-hole scattering rate limits the maximum kinetic energy attainable by the electrons and thus reduces the observed nonlinear absorption.

Two molecular weight species of thrombospondin-2 are present in bone and differentially modulated in fractured and nonfractured tibiae in a murine model of bone healing

We report two immuoreactive species of thrombospondin-2 (TSP2), sized approximately 200 and 125 kDa, in the long bones of growing, but not skeletally mature, mice. In vitro osteoblasts secrete a 200-kDa species into the culture medium as early as day 3, and it appears in the cell-matrix layer by day 7. A 125-kDa species appears in the cell-matrix layer in parallel with mineralization; it is not detected in cell-conditioned medium. Unilateral tibial fracture induced a time-dependent upregulation of the 200-kDa species at the site of trauma. By contrast, relative levels of the 125-kDa species at the fracture site were lower than in bones from naive control animals. In the contralateral untouched control tibia, the 200-kDa species was rapidly and substantially reduced compared to bone harvested from naive control mice. Levels of the 125-kDa species in the untouched tibia declined gradually with time postfracture. TSP2 gene expression in uninjured control bone decreased modestly by 21 days postfracture. On the day of fracture, the osteoblast differentiation potential of MSCs harvested from uninjured bones decreased compared to those harvested from naive control animals. The presence of two isoforms suggests that TSP2 may undergo posttranscriptional or posttranslational processing in skeletal tissue. Our data also suggest that, in the context of trauma, the two TSP2 isforms are differentially modulated at injured and noninjured skeletal sites in an animal undergoing fracture healing.

Ipsilateral shoulder and elbow dislocation: a case report

ABSTRACT

Simultaneous ipsilateral shoulder and elbow joint dislocation is a rare injury. In most reported cases, shoulder joint dislocation was missed and diagnosed at a later time. We present the case of a 30-year-old male who dislocated his ipsilateral shoulder and elbow joint following a motor vehicle accident. Keeping a high index of suspicion, radiographs of both joints were obtained. Under general anaesthesia, the elbow joint was reduced before the shoulder joint. In the final follow up after 1.5 years, the patient had returned to his occupation and enjoyed a full range of motion. The purpose of this report is to describe a very rare injury and to emphasise the importance of maintaining a high index of suspicion in such cases.

KEY WORDS

Dislocation, shoulder, elbow, ipsilateral.

Pharmacovigilance of herbal products in India

Herbal formulations being widely accepted therapeutic agents as antidiabetics, antiarthritics, hepatoprotectives, cough remedies, memory enhancers, and adaptogens. The commonest myth regarding herbal medicines is that these medicines are completely safe, and can therefore be safely consumed by the patient on his/her own, without a physician's prescription. This belief has led to large-scale self-medication by people all over the world, often leading to disappointing end-results, side-effects, or unwanted after-effects. There is an increasing awareness at several levels of the need to develop pharmacovigilance practices for herbal medicines. The current model of pharmacovigilance and its associated tools have been developed in relation to synthetic drugs, and applying these methods to monitoring the safety of herbal medicines presents unique challenges in addition to those described for conventional medicines. Several problems relate to the ways in which herbal medicines are named, perceived, sourced, and utilized. This may be because of differences in the use of nonorthodox drugs (e.g., herbal remedies) which may pose special toxicological problems, when used alone or in combination with other drugs. The purpose of pharmacovigilance is to detect, assess, and understand, and to prevent the adverse effects or any other possible drug-related problems, related to herbal, traditional, and complementary medicines.

State of maternal, newborn and child health programmes in Nepal: what may a continuum of care model mean for more effective and efficient service delivery?

The cost-effective interventions exist across the continuum of maternal to child survival at each level of the health system that can contribute to achieve the Millennium Development Goals 4 and 5. However, implementation inefficiency, low coverage and equity gaps along this continuum remain a serious challenge to Nepal's efforts to achieve these goals. This paper proposes a continuum of care model; discusses the readiness of policy and programs to provide high impact interventions across the continuum; identifies existing gaps in MNCHN programs; and recommends policy and program actions to improve coverage, equity, effectiveness and efficiency along the continuum of MNCHN service delivery in Nepal. The literature review includes systematic desk review, followed by discussions and deliberations amongst a group of professionals and MNCH experts in Nepal. Within the government health system in Nepal, a continuum of care approach is feasible, as policies and plans exist to ensure an integrated approach across the maternal to child care continuum. However, health programs largely remain vertically oriented. Achieving integration across the maternal to child continuum of care remains a challenge at each level of health system. An integrated system of program management for maternal, newborn and child health would be a feasible solution to enable an efficient and effective delivery of intervention packages. A collaborative and partnership approach to strengthen health systems, building managerial capacity, improving governance and engaging the private and civil sectors remains vital to achieve effective coverage and improve equity across the continuum of care.

Effective mass anisotropy of hot electrons in nonparabolic conduction bands of n-doped InGaAs films using ultrafast terahertz pump-probe techniques

The anisotropic effective mass of energetic electrons in an isotropic, nonparabolic conduction band is revealed using ultrafast THz-pump-THz-probe techniques in a n-doped InGaAs semiconductor thin film. A microscopic theory is applied to identify the origin of the observed anisotropy and to show that the self-consistent light-matter coupling contributes significantly to the THz response.