Estimating and Rewarding the Value of Healthcare Interventions Beyond the Healthcare Sector: A Conceptual Framework

BACKGROUND

Evaluating healthcare interventions for their impacts beyond health outcomes may result in recognition of changes in human capital, income level, tax revenue, and government spending, which could affect economic growth and population health. In this paper, we document instances where current health technology assessment (HTA) practices fail to account for the impacts of healthcare interventions on broader society beyond the healthcare sector.

METHODS

We propose a novel conceptual framework, highlighting its three components (distributional cost-effectiveness analysis [DCEA], input-output model, and voting scheme) and their contributions to capturing the economic and societal ripple effects of healthcare interventions. This manuscript also outlines a case study in which the framework is applied to the reassessment of a previously evaluated digital health therapeutic for the treatment of opioid use disorder (OUD) compared with standard of care, demonstrating its practical application.

RESULTS

The DCEA health value metric indicates that digital therapeutic is more equitable, favoring socioeconomically disadvantaged groups, while standard of care exacerbates health inequality by benefiting the already advantaged. Additionally, digital therapeutic shows potential for boosting productivity, raising income, and creating jobs, supporting its consideration by employer-sponsored health plans to optimize resource allocation for treating OUD.

CONCLUSION

The conceptual framework provides insights for enhancing HTAs to incorporate the broader economic and societal impacts of healthcare interventions. By integrating DCEA, extended HTA analysis with input-output modeling, and a voting scheme, decision makers can make informed choices aligned with societal priorities, although further research and validation are necessary for practical implementation across diverse healthcare contexts.

Multi-level optimal energy management strategy for a grid tied microgrid considering uncertainty in weather conditions and load

Microgrids require efficient energy management systems to optimize the operation of microgrid sources and achieve economic efficiency. Bi-level energy management model is proposed in this paper to minimize the operational cost of a grid-tied microgrid under load variations and uncertainties in renewable sources while satisfying the various technical constraints. The first level is day ahead scheduling of generation units based on day ahead forecasting of renewable energy sources and load demand. In this paper, a recent meta-heuristic algorithm called Coronavirus Herd Immunity Optimizer (CHIO) is used to solve the problem of day-ahead scheduling of batteries, which is a complex constrained non-linear optimization problem, while the Lagrange multiplier method is used to determine the set-point of the Diesel Generator (DG). The second level of the proposed EMS is rescheduling and updating the set-points of sources in real-time according to the actual solar irradiance, wind speed, load, and grid tariff. In this paper, a novel real-time strategy is proposed to keep the economic operation during real-time under uncertainties. The obtained results show that the CHIO-based bi-level EMS demonstrates an optimal economic operation for a grid-connected microgrid in real-time when there are uncertainties in weather, utility tariffs, and load forecasts.

A comprehensive investigation of Bi2O3 on the physical, structural, optical, and electrical properties of K2O.ZnO.V2O5.B2O3 glasses

The multi-component glass system has a composition of 10K2O-10ZnO-55 B2O3-(25-x)V2O5-xBi2O3 (x = 4, 5, 7.5, 9, 10 mol%) are synthesized by the melt-quenching method. Using X-ray diffraction examination, the amorphous phase in the material was confirmed. The physical characteristics of the produced compositions are examined using density (D) and molar volume (Vm). Calculations of physical properties showed that adding Bi2O3 from 4 to 10 mol% increased the glass density from 2.7878 to 3.3617 g cm-3 and decreased the molar volume from 40.4196 to 38.5895 cm3/mol. Studies of glass samples using the FTIR show bands of absorption for oxides in different structural groups. Octahedral [ BiO 6 ], [ BO 4 ], and tetrahedral [ BO 3 ] structural units are observed in the present glass matrices. The cutoff wavelength ( λ C ), and optical band gap energy were determined using UV absorption spectra. The increase in non-bridging oxygens can be linked to the decrease in optical band gap energy ( E opt ) (direct and indirect) and the increase in cutoff wavelength with an increase in Bi2O3 content. This is attributed to the existence of bismuth ions and the creation of non-bridging oxygens. Besides that, the values of optical parameters, viz., optical electronegativity, refractive index, and molar refractivity, are calculated. The metallization criterion values are less than 1 and the glass samples exhibit an increased tendency towards metallization. Both the conductivity and the dielectric constant increase with the rise in Bi2O3 content, however, the dielectric loss and the impedance reduce. The behavior and values of conductivity for the studied glasses reveal the semiconducting properties of all glass samples. These results suggest that the produced glass samples may be employed as amorphous semiconductors in electronics and memory switching devices.

A comparative study of advanced evolutionary algorithms for optimizing microgrid performance under dynamic pricing conditions

The integration of microgrids into the existing power system framework enhances the reliability and efficiency of the utility grid. This manuscript presents an innovative mathematical paradigm designed for the optimization of both the structural and operational aspects of a grid-connected microgrid, leveraging the principles of Demand-Side Management (DSM). The focus of this work lies in a comprehensive exploration of the implications brought about by the Renewable Generation-Based Dynamic Pricing Demand Response (RGDP-DR) mechanism, particularly in terms of its influence on the optimal microgrid configuration, considering perspectives from end-users and the utility entity. This inquiry is rooted in a holistic assessment that encompasses technical and economic performance benchmarks. The RGDP-induced DR framework adeptly addresses the needs of the consumer base, showcasing notable efficiency and economic feasibility. To address the intricate nonlinear optimization challenge at hand, we employ an evolutionary algorithm named the "Dandelion Algorithm" (DA). A rigorous comparative study is conducted to evaluate the efficacy of four optimization techniques, affirming the supremacy of the proposed DA. Within this discourse, the complexity of microgrid sizing is cast as a dual-objective optimization task. The twin objectives involve minimizing the aggregate annual outlay and reducing emissions. The results of this endeavor unequivocally endorse the superiority of the DA over its counterparts. The DA demonstrates exceptional proficiency in orchestrating the most cost-effective microgrid and consumer invoice, surpassing the performance of alternative optimization methodologies.

The role of diffusion-weighted MRI in the accurate diagnosis of vertebral compression fractures: A comparative study

INTRODUCTION

Accurately distinguishing between benign and malignant vertebral compression fractures is crucial for clinical management. This study evaluated the predictive accuracy of diffusion-weighted imaging (DWI) in differentiating the cause of vertebral fractures using MRI.

METHODS

A longitudinal cross-over study was conducted at Jinnah Postgraduate Medical Centre (JPMC) Karachi from July 2018 to January 2021. Patients with vertebral compression fractures underwent T1-weighted, T2-weighted, and DWI imaging with ADC mapping on a 1.5 T MRI scanner. Imaging findings were compared with histopathologic results and clinical follow-up. Sensitivity, specificity, and ROC curve analyses were performed.

RESULTS

The study enrolled 303 patients with a mean age of 43.6 ± 10.9 years, of whom 118 were male. DWI demonstrated high accuracy in predicting the cause of vertebral compression fractures, with a sensitivity of 96.2 %, a specificity of 76.2 %, and an area under the ROC curve of 0.857. The optimal ADC cut-off value was 0.82 × 10˄-3 mm˄2/s, which yielded a positive predictive value of 79.7 % and a negative predictive value of 95.4 %.

CONCLUSIONS

DWI is a safe and non-invasive imaging modality with excellent predictive accuracy in differentiating between benign and malignant vertebral compression fractures. Iso- or hypointensity of collapsed vertebral bodies on DWI suggests a benign lesion, while T2-weighted hyperintensity is highly indicative of malignancy. Low signal on ADC is also highly indicative of malignant vertebral fractures. Incorporating DWI improves accuracy in assessing vertebral lesions, especially when standard sequences are inconclusive.

IMPLICATIONS FOR PRACTICE

DWI revolutionizes vertebral compression fracture diagnosis, distinguishing between benign and malignant cases. This precision guides treatment decisions, minimizing the necessity for invasive procedures like biopsy. As a safe and reliable imaging method, DWI elevates patient care, ensuring accurate diagnostics and improved outcomes.

The State of Pharmacoeconomics Education in the Doctor of Pharmacy Curriculum amid the Changing Face of Pharmacy Practice

(1) Background: Continuous growth in pharmaceutical expenditure indicates the need for more advanced pharmacoeconomics evaluations to optimize healthcare outcomes and resource allocation. This study assesses the extent to which accredited pharmacy colleges in the United States cover pharmacoeconomics content within the didactic curriculum of their Doctor of Pharmacy (PharmD) programs. (2) Methods: We conducted a systematic search of the websites of accredited professional-degree programs in pharmacy schools located in the United States to identify pertinent content related to pharmacoeconomics. (3) Results: Out of 141 pharmacy programs, a total of 111 programs of varying sizes were found to have publicly accessible information regarding the content of their pharmacoeconomic curricula on their websites. All these programs required the inclusion of pharmacoeconomics content in their curricula. An examination of course syllabi revealed that the goals and descriptions were broad, aiming to provide students with an introductory understanding of the principles of pharmacoeconomics. The number of credit hours allocated to pharmacoeconomics education ranged from one to seven across the programs. The approach to delivering pharmacoeconomics content varied among the programs. (4) Conclusions: Advanced knowledge of the principles of pharmacoeconomics must be an integral component of all PharmD curricula to prepare pharmacists to assess the rational use of pharmacy products and services, improve clinical outcomes, and mitigate healthcare expenditures.

Machine learning algorithms to predict major adverse cardiovascular events in patients with diabetes

BACKGROUND

Major Adverse Cardiovascular Events (MACE) are common complications of type 2 diabetes mellitus (T2DM) that include myocardial infarction (MI), stroke, and heart failure (HF). The objective of the current study was to predict MACE among T2DM patients.

METHODS

Type 2 diabetes mellitus patients above 18 years old were recruited for the study from the All of Us Research Program. Eligible participants were those who took sodium-glucose cotransporter 2 inhibitors. Different Machine learning algorithms: including RandomForest (RF), XGBoost, logistic regression (LR), and weighted ensemble model (WEM) were employed. Clinical attributes, electrolytes and biomarkers were explored in predicting MACE. The feature importance was determined using mean decrease accuracy.

RESULTS

Overall, 9, 059 subjects were included in the analyses, of which 5197 (57.4%) were females. The XGBoost Model demonstrated a prediction accuracy of 0.80 [0.78-0.82], which is higher as compared to the RF 0.78[0.76-0.80], the LR model 0.65 [0.62-0.67], and the WEM 0.75 [0.73-0.76], respectively. The classification accuracy of the models for stroke was more than 95%, which was higher than prediction accuracy for MI (∼85%), and HF (∼80%). Phosphate, blood urea nitrogen and troponin levels were the major predictors of MACE.

CONCLUSION

The ML models had shown acceptable performance in predicting MACE in T2DM patients, except the LR model. Phosphate, blood urea nitrogen, and other electrolytes were important predictors of MACE, which is consistent between the individual components of MACE, such as stroke, MI, and HF. These parameters can be calibrated as prognostic parameters of MACE events in T2DM patients.

Application of Machine Learning Algorithms to Predict Uncontrolled Diabetes Using the All of Us Research Program Data

There is a paucity of predictive models for uncontrolled diabetes mellitus. The present study applied different machine learning algorithms on multiple patient characteristics to predict uncontrolled diabetes. Patients with diabetes above the age of 18 from the All of Us Research Program were included. Random forest, extreme gradient boost, logistic regression, and weighted ensemble model algorithms were employed. Patients who had a record of uncontrolled diabetes based on the international classification of diseases code were identified as cases. A set of features including basic demographic, biomarkers and hematological indices were included in the model. The random forest model demonstrated high performance in predicting uncontrolled diabetes, yielding an accuracy of 0.80 (95% CI: 0.79-0.81) as compared to the extreme gradient boost 0.74 (95% CI: 0.73-0.75), the logistic regression 0.64 (95% CI: 0.63-0.65) and the weighted ensemble model 0.77 (95% CI: 0.76-0.79). The maximum area under the receiver characteristics curve value was 0.77 (random forest model), while the minimum value was 0.7 (logistic regression model). Potassium levels, body weight, aspartate aminotransferase, height, and heart rate were important predictors of uncontrolled diabetes. The random forest model demonstrated a high performance in predicting uncontrolled diabetes. Serum electrolytes and physical measurements were important features in predicting uncontrolled diabetes. Machine learning techniques may be used to predict uncontrolled diabetes by incorporating these clinical characteristics.

Health-Related Quality of Life and Healthcare Events in Patients with Monotherapy of Anti-Diabetes Medications

This study aimed to examine the difference in health-related quality of life (HRQOL) and diabetes-related healthcare events (HCEs) among adults with diabetes who were on metformin, sulfonylurea, insulin, or thiazolidinedione (TZD) monotherapy. The data were sourced from the Medical Expenditure Panel Survey (MEPS). Diabetes patients ≥18 years old who had a complete record of physical component score and mental component scores in round 2 and round 4 of the survey were included. The primary outcome was HRQOL of diabetes patients as measured by the Medical Outcome Study short-form (SF-12v2^TM). Multinomial logistic regression and negative binomial regression were conducted to determine associated factors of HRQOL and HCE, respectively. Overall, 5387 patients were included for analysis. Nearly 60% of patients had unchanged HRQOL after the follow-up, whereas almost 15% to 20% of patients showed improvement in HRQOL. The relative risk of declined mental HRQOL was 1.5 times higher relative to unchanged mental HRQOL in patients who were on sulfonylurea 1.55 [1.1-2.17, p = 0.01] than metformin users. The rate of HCE decreased by a factor of 0.79, [95% CI: 0.63-0.99] in patients with no history of hypertension. Patients on sulfonylurea 1.53 [1.20-1.95, <0.01], insulin 2.00 [1.55-2.70, <0.01], and TZD 1.78 [1.23-2.58, <0.01] had increased risk of HCE compared to patients who were on metformin. In general, antidiabetic medications modestly improved HRQOL in patients with diabetes during the follow-up period. Metformin had a lower rate of HCE as compared to other medications. The selection of anti-diabetes medications should focus on HRQOL in addition to controlling glucose level.

Comparative cost-effectiveness of radiotherapy among older women with hormone receptor positive early-stage breast cancer

OBJECTIVE

The aim was to examine the real-world cost-effectiveness of breast-conserving surgery (BCS) plus hormonal therapy with radiotherapy, compared to hormonal therapy alone among women 66 and older with hormone receptor positive early-stage breast cancer in the United States (US).

METHODS

This study was conducted from a U.S. Centers for Medicare and Medicaid Services perspective and an eight-year time horizon. Both costs (2020 US$) and health utilities (quality-adjusted life years, QALYs) were obtained from retrospective studies using the SEER linked with Medicare and Medicare Health Outcomes Survey, respectively. The incremental cost-effectiveness ratio (ICER) of the addition of radiotherapy to hormonal therapy versus hormonal therapy alone after BCS was estimated by an unbiased doubly robust estimator. Sensitivity analyses were conducted through bootstrapping to estimate credible intervals.

RESULTS

The addition of radiotherapy to hormonal therapy after BCS yielded the highest clinical benefits (2.66 QALYs) and costs ($19,424.27) compared to its hormonal therapy alone after BCS (0.77 QALYS; $2,028.58). The ICER was estimated to be $9,174.94/QALY. Sensitivity analyses did not change the direction of the findings.

CONCLUSIONS

The results implicated that the combination of radiotherapy and hormonal therapy is cost-effective in the US.

A randomized controlled trial comparing the effects of Vitamin E, Ursodeoxycholic acid and Pentoxifylline on Egyptian non-alcoholic steatohepatitis patients

OBJECTIVE

Currently, no NASH-specific therapies are approved by the US Food and Drug Administration. This study aimed to compare the clinical effect of vitamin E (Vit. E), Ursodeoxycholic Acid (UDCA) and pentoxifylline (PTX) on Egyptian patients with NASH with exploration of their possible roles on inflammatory cytokines and chemokines mainly Interleukin 6 (IL6) and Monocyte Chemoattractant Protein-1 (CCL2/MCP-1).

PATIENTS AND METHODS

We conducted a 3-month, randomized, single-blind study in 102 Egyptian NASH patients who were divided into three groups; group 1 received Vit. E 400 mg twice a day, group 2 received UDCA 250 mg twice a day and group 3 received PTX 400 mg twice daily. Liver aminotransferases (AST, ALT), IL6, CCL2/MCP-1, albumin, bilirubin, and lipid panel were measured both before and after intervention intake.

RESULTS

A significant decrease was found in liver aminotransferases, serum cytokine and chemokine in participants after Vit. E, UDCA or PTX intake. Compared to the UDCA and PTX groups, liver aminotransferases, serum cytokine and chemokine showed a more statistically significant reduction after Vit. E administration (50%, 43%, 57% and 55% for ALT, AST, IL6 and CCL2/MCP-1, respectively). In contrast, other biochemical tests showed non-significant change after any drug intake. None of the tested drugs showed significant safety issues in this population.

CONCLUSIONS

Treatment with Vit. E, UDCA and PTX was both safe and effective in improving hepatic aminotransferases and inflammatory markers in Egyptian NASH patients. The superior effect of Vit. E compared to UDCA and PTX may suggest that oxidative stress plays a key role in disease progression of NASH patients. Moreover, IL6 and CCL2/MCP-1 may be used with or without ALT for treatment evaluation of NASH people.

Foliar micromorphology, ultrastructure and histochemical analyses of Tagetes minuta L. leaves

Many Tagetes species are known for producing essential oils and commercially useful bioactive compounds. This study investigated the micromorphological features of the internal and external foliar structures of Tagetes minuta that produce and store these compounds. Stereomicroscopy, light microscopy, scanning electron microscopy, transmission electron microscopy, and histochemical analyses were used to examine T. minuta leaves at three developmental stages. The development of the subdermal secretory cavities revealed that the cells undergo autolysis to form a schizolysigenous cavity in the mature leaves. The ultrastructure of the parenchymal sheath and secretory epithelium within the secretory cavity revealed that plastids change to contain lipid and osmiophilic molecules. The histochemical analyses showed that trichomes on the surface of T. minuta leaves appear to be linear and non-glandular but maintain the ability to store bioactive phytocompounds. These are new findings for T. minuta and provide a better understanding of the exudation process, which can help to optimise essential oil production for industrial applications.

Pharmacokinetic interaction between atorvastatin and fixed-dose combination of sofosbuvir/ledipasvir in healthy male Egyptian volunteers

PURPOSE

Comorbid conditions of heart and liver disorders added to HCV-induced hepatic steatosis make co-administration of statins, and direct-acting antivirals is common in clinical practice. This study aimed to evaluate the pharmacokinetic interaction of atorvastatin and fixed-dose combination of sofosbuvir/ledipasvir "FDCSL" with rationalization to the underlying mechanism.

METHODS

A randomized, three-phase crossover study that involves 12 healthy volunteers was performed. Participants received a single-dose of atorvastatin 80 mg alone, atorvastatin 80-mg plus tablets containing 400/90 mg FDCSL, or tablets containing 400/90 mg FDCSL alone. Plasma samples were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) for atorvastatin, sofosbuvir, ledipasvir, and sofosbuvir metabolite "GS-331007," and their pharmacokinetics parameters were determined.

RESULTS

Compared to atorvastatin alone, the administration of FDCSL caused a significant increase in both areas under the concentration-time curve from time zero to infinity (AUC_0-∞) and maximum plasma concentration (C_max) of atorvastatin by 65.5% and 156.0%, respectively. Also, atorvastatin caused a significant increase in the AUC_0-∞ and C_max of sofosbuvir by 32.0% and 11.0%, respectively. Similarly, AUC_0-∞ and C_max of sofosbuvir metabolite significantly increased by 84.0% and 74.0%, respectively. However, ledipasvir AUC_0-∞ showed no significant change after atorvastatin intake. The elimination rate in all drugs revealed no significant changes.

CONCLUSION

After concurrent administration of FDCSL with atorvastatin, the AUC_0-∞ of both atorvastatin and sofosbuvir were increased. Caution should be taken with close monitoring for possible side effects after co-administration of atorvastatin and FDCSL in clinical practice.

Bioactive constituents from Thunbergia erecta as potential anticholinesterase and anti-ageing agents: Experimental and in silico studies

Acetylcholinesterase (AChE) inhibitor and telomerase reverse transcriptase (TERT) potentiator phytochemicals are highly targeted as anti-Alzheimerꞌs disease and as an anti-ageing process. A phytochemical study of Thunbergia erecta aerial parts resulted in the isolation of ten compounds (1-10). Their structures were identified based on spectral data and comparison with literature values. The activity of our pure isolates on AChE and TERT enzymes by documented in vitro assay methods were evaluated. The results indicated that apigenin (2), vanillic acid (4), and acacetin-7-O-β-D-glucoside (7) exhibited potent inhibition of AChE (IC₅₀ 37.33, 30.80 and 49.57 ng/mL, respectively), compared to the standard drug donepezil (IC₅₀ 31.25 ng/mL). In the TERT enzyme assay, compound 7 triggered a 1.66‑fold increase in telomerase activity at the concentration of 2.85 ng/ml. This is the first study that demonstrates that compound 7 isolated from T. erecta can lead to such telomerase activity relative to control cells. Virtual screening studies including docking, rapid overlay chemical structure (ROCS), and calculated structure-property relationships (SPR) were implemented in this work. Molecular docking studies supported the binding of compounds 2, 4, and 7 through hydrogen bonds (HBs) formation to essential amino acid residues namely ARG:24 A, SER:347 A, LYS:51 A, PHE:346 A, and GLY:345 A of acetylcholinesterase. ROCS and SPR analyses realized compound 2 as a possible treatment of Alzheimer's disease and as a lead compound for drug development process through applying semisynthetic modifications.

Using time series analysis to forecast the health-related quality of life of post-menopausal women with non-metastatic ER+ breast cancer: A tutorial and case study

BACKGROUND

Time series models are widely used forecasting techniques in health care for long time series and are typically built in commercial statistical packages. However, for short time series data, such as health-related quality of life (HRQoL), guidance on how to select and use appropriate time series models is lacking. This tutorial provides a step-by-step guide adopting a time series analysis framework for HRQoL forecasting.

OBJECTIVE

We walk through a case study examining the forecasting of the effects of adjuvant endocrine therapy on the HRQoL of post-menopausal women with non-metastatic ER + breast cancer using data from the HRQoL sub-protocol of the Tamoxifen arm of the Arimidex, tamoxifen, alone or in combination (ATAC) trial.

METHODS

The forecasting of HRQoL consists of four steps: 1) data extraction and accuracy check, 2) forecasting horizon definition and identification of data pattern, 3) forecasting model identification and fitting using five forecasting approaches appropriate for short time series ((i) double exponential smoothing, (ii) double moving average, (iii) fuzzy forecasting, (iv) grey forecasting, and (v) Volterra series), 4) forecasting model selection. A user-friendly visual basic for applications (VBA) Excel add-in is made available to interested users to facilitate the application of the tutorial.

RESULTS

The Grey method and Volterra series appeared to be good candidates to forecast the effects of adjuvant endocrine therapy on the HRQoL of post-menopausal women with non-metastatic ER + breast cancer enrolled in the ATAC trial.

CONCLUSION

It is feasible to forecast the effects of treatments on HRQOL even when the time series is short.

Double vest lipodermal flaps for depressed facial scars

INTRODUCTION

Depressed tethered scar is a common problem that can cause emotional, social and behavioural problems, especially when it involves the exposed body parts. Several techniques have been described for treating these depressed scars, but none of these can fulfil the optimal results.

AIM

Evaluating the aesthetic outcome of using a double vest lipodermal flaps for treating depressed facial scars.

MATERIALS AND METHODS

The study included 25 patients with depressed facial scars who underwent scar revision. Their mean age was 31 years. Under local anaesthesia, the scarred area was de-epithelialised and double dart lipodermal flaps were used for revision. Visual analogue and Vancouver scar scales were used as subjective and objective parameters of evaluation, respectively.

RESULTS

All the patients followed up for five to eight months. No complications were observed during the scar healing period. Patients satisfaction according to the visual analogue scale showed an average value of 8. The mean total scale according to the Vancouver scar scale was 2.6.

CONCLUSION

The new technique of using double vest lipodermal flaps is simple and offers a promising alternative for revising depressed scars.

Real-World Clinical and Economic Outcomes Associated with Palbociclib for HR-Positive/HER2 Negative Metastatic Breast Cancer: A Commentary

Despite the achieved advancement in pharmacological cancer treatments, the majority of postmenopausal women with hormone receptor-positive metastatic breast cancer (mBC) will experience disease progression. Research into alternative therapies with improved efficacy and reduced side effects has led to the development of a new class of oral anticancer medications, the cyclin-dependent kinase (CDK) 4/6 inhibitors, which include palbociclib, ribociclib, and abemaciclib. Nonetheless, there is growing evidence that the effectiveness of oral anticancer medications is sub-optimal, being influenced by low adherence, sociodemographic factors, and adverse effect profiles. In addition, there is a disconnect between the high price tags of CDK 4/6 inhibitors and their observed effectiveness, raising questions about their value. Currently, the existing knowledge base on the effectiveness and cost-effectiveness of newer oral anticancer medications in understudied populations with possible health disparities is scant. This commentary discusses what is known about palbociclib's clinical effectiveness, safety, and adherence and suggests the need for further studies of real-world effectiveness and cost-effectiveness to help establish the value of newer oncologic drugs, such as palbociclib. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.

A cost-effectiveness analysis of trastuzumab-containing treatment sequences for HER-2 positive metastatic breast cancer patients in Taiwan

OBJECTIVE

Treatment options for HER-2-positive metastatic breast cancer (mBC) patients have expanded markedly since trastuzumab approval in 1998. Several other regimens are now available, including pertuzumab plus trastuzumab plus docetaxel, T-DM1, capecitabine plus lapatinib, and trastuzumab plus lapatinib. This study assesses the cost-effectiveness of four treatment sequences for HER-2-positive mBC according to the Taiwanese National Health Insurance Administration (TNHIA).

METHODS

Costs (U.S. Dollars) and effectiveness (quality-adjusted life years) of four treatment sequences for HER-2-positive mBC patients were examined using a Markov model over a lifetime horizon. Transition probabilities, disease progression, and probability of adverse events and survival were derived from clinical trial data. Costs and health utilities were estimated from TNHIA, Taipei Medical University Hospital, and the literature. Deterministic, probabilistic sensitivity analyses and a scenario analysis examined parameter uncertainty and accounted for drug wastage in dosage and cost calculations.

RESULTS

Sequence 3 (1st line: trastuzumab plus docetaxel; 2nd line: T-DM1; 3rd line: trastuzumab plus lapatinib) was the most cost-effective sequence followed by sequence 1 (1st line: pertuzumab plus trastuzumab plus docetaxel; 2nd line: T-DM1; 3rd line: capecitabine plus lapatinib), and sequence 4 (1st line: trastuzumab plus docetaxel; 2nd line: trastuzumab plus lapatinib; 3rd line: trastuzumab plus capecitabine), respectively. The model was sensitive to costs and transition probabilities, but not particularly sensitive to the wastage assumption.

CONCLUSIONS

From the perspective of the TNHIA, trastuzumab plus docetaxel as 1st line followed by T-DM1 and trastuzumab plus lapatinib as 2nd and 3rd line represents the most cost-effective strategy among the four sequences considered for treating HER-2-positive mBC patients.

Dataset used in the economic evaluation trastuzumab-based regimens for HER-2 positive metastatic breast cancer patients in the Taiwanese healthcare setting

The present data article aims to describe the input parameters for a Markov model assessing the cost-effectiveness of four treatment sequences for patients with HER-2 positive metastatic breast cancer. The model input parameters include costs for physician visits, drugs, adverse event management, computed tomography (CT) scan, laboratory tests, echocardiogram, utilities, disutilities as well as the shape and scale parameters of a log-logistic distribution used for the transition probabilities.

Fabrication of a novel low-cost superoleophilic nonanyl chitosan-poly (butyl acrylate) grafted copolymer for the adsorptive removal of crude oil spills

A novel superoleophilic-hydrophobic nonanyl chitosan-poly (butyl acrylate) grafted copolymer was fabricated as a low-cost oil-adsorbent. Chitosan (CS) was coupled with a hydrophobic nonanal (N) to form nonanyl chitosan (NCS) schiff base, and followed by grafting with butyl acrylate monomers (ButA). The grafted copolymer was characterized by FTIR, TGA and SEM tools. The grafting percent was augmented and reached 88.5% with increasing ButA concentration up to 156 mM. Moreover, measurements of contact angle proved the superoleophilic character of NCS-g-poly (ButA) copolymer with an oil-contact angle 31°. Factors affecting the removal process such as contact time, oil type, oil dose, adsorbent dose, temperature and agitation speed were optimized. An increment in the oil removal (%) was observed with increasing the oil viscosity in the order of gasoil < mobil-1 oil < light crude oil < heavy crude oil. Besides, the adsorption process followed the pseudo-second order model and the equilibrium data were sufficiently fitted with the Langmuir model with a maximum adsorption capacity 108.79 g/g at 25 °C. Thermodynamic parameters computed from Van't Hoff plot confirmed the process to be exothermic, favorable and spontaneous. The results nominate the superoleophilic adsorbent as a potential oil- adsorbent for petroleum oil spills removal.

Insights into pathological and molecular characterization of avipoxviruses circulating in Egypt

1. Avipoxvirus (APV) infections are one of many threats inflicting economic losses within the poultry industry, particularly in tropical and subtropical countries. A proper and comprehensive study for APVs is needed to increase the knowledge concerning the diversity and evolution of the virus.2. For this purpose, 136 bird flocks of different species and breeding types were examined for APV infection between October 2016 and November 2017. One hundred and thirty samples had visible pocks on the chorioallantoic membrane (CAM) which were designated as fowl pox-like viruses via amplification of 578 bp from the P4b gene and 1800 bp from the fpv140 locus.4. A comprehensive phylogenetic analysis of fpv167 locus (P4b), fpv140 locus (fpv139 and fpv140) and fpv94 (DNA polymerase) revealed that all the analysed strains belong to fowl pox-like viruses (clade A; subclade A1 and A2). Based on the fpv140 locus full nucleotide sequence, three turkey originated strains were seen to be divergent from chicken originated sequences and branched into novel subclade A1.b.5. Trees comparison, within the term of speculation of virus-host specificity, clearly highlighted a high order specific subgrouping among subclades in the case of the fpv140 locus (including fpv139 and fpv140). Hence, the fowl poxvirus, turkey poxvirus and pigeon poxvirus strains clustered into distinct host-specific subclades A1a, A1.b and A2, respectively, which could not be seen in the FWPV-P4b and DNA polymerase phylogeny.

Extreme tuning of wetting on 1D nanostructures: from a superhydrophilic to a perfect hydrophobic surface

The tuning of wetting over an extreme range, from superhydrophilic to superhydrophobic, was demonstrated on 1D Al/Al₂O₃ nanostructures. While chaotic and tangled 1D Al/Al₂O₃ nanostructures exhibited complete wetting, they became water repellent (with a water contact angle (CA) ≥173°) after the infiltration of poly[bis(2,2,2-trifluoroethoxy)phosphazene] (PTFEP) solution. This simple strategy allows the achievement of two extreme wetting regimes, perfect wetting and non-wetting, without altering the nanostructured surface topography. The same surface was also found to exhibit repellency towards artificial blood and hexadecane.

Effect of subchronic intake of green tea extract on liver of albino rat histomorphometric, ultrastructural and biochemical study

BACKGROUND

There are conflicting reports on the effect of green tea extract (GTE) on the liver of animals. Some studies failed to show any adverse hepatic effects following administration of GTE to mice, rats, and dogs. Others reported severe hepatic necrosis, resulting in death in female Swiss-Webster mice following its administration. The aim of the study was to examine the subchronic toxicity of GTE on the liver of the adult male albino rats.

MATERIALS AND METHODS

Forty male adult Wistar albino rats were used in the study. The rats were divided into four groups; group I (control), group II (low-dose green tea), group III (medium-dose green tea) and group IV (high-dose green tea). Histological, biochemical and histomorphometric analyses were done.

RESULTS

Mild hepatic affections were observed in group II. The affections were severe in groups III and IV. The central veins and hepatic sinusoids were congested. The hepatocytes were degenerated. Hypertrophy of the hepatic arteries, dilation of the bile ducts and cellular infiltration were clearly observed in the last two groups. Mild degenerative changes were observed in the hepatocytes in rat's group II; the cytoplasm was rarefied and vacuolated. Some mitochondria were ruptured. The blood sinusoids were congested. The rough endoplasmic retinaculum was fragmented in group III. More degenerative changes were observed in group IV; the hepatic architectures were lost with disruption of cell membranes. Most of the cell organelles were degenerated and most of mitochondria were ballooned. As compared to that of the control groups: the total serum protein values in groups II, III and IV showed a statistically significant decrease (12%, 20% and 21%, respectively), the mean area per cent of collagen fibres in groups III and IV increased 5 and 7 folds.

CONCLUSIONS

Subchronic administration of GTE resulted in structural and functional affection of the rats' liver. The dose of 250 mg/kg/day seemed to be safe, while the doses of 500 mg/kg/day and 1000 mg/kg/day had deleterious effect being more evident in the latter dose.

Comparison of health utility weights among elderly patients receiving breast-conserving surgery plus hormonal therapy with or without radiotherapy

BACKGROUND

The selection of the most appropriate treatment combinations requires the balancing of benefits and harms of these treatment options as well as the patients' preferences for the resulting outcomes.

OBJECTIVE

This research aimed at estimating and comparing the utility weights between elderly women with early stage hormone receptor positive (HR+) breast cancer receiving a combination of radiotherapy and hormonal therapy after breast conserving surgery (BCS) and those receiving a combination of BCS and hormonal therapy.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) linked with Medicare Health Outcomes Survey (MHOS) was used as the data source. Health utility weights were derived from the VR-12 health-related quality of life instrument using a mapping algorithm. Descriptive statistics of the sample were provided. Two sample t-tests were performed to determine potential differences in mean health utility weights between the two groups after propensity score matching.

RESULTS

The average age at diagnosis was 72 vs. 76 years for the treated and the untreated groups, respectively. The results showed an inverse relationship between the receipt of radiotherapy and age. Patients who received radiotherapy had, on average, a higher health utility weight (0.70; SD = 0.123) compared with those who did not receive radiotherapy (0.676; SD = 0.130). Only treated patients who had more than two comorbid conditions had significantly higher health utility weights compared with patients who were not treated.

CONCLUSIONS

The mean health utility weights estimated for the radiotherapy and no radiotherapy groups can be used to inform a comparative cost-effectiveness analysis of the treatment options. However, the results of this study may not be generalizable to those who are outside a managed care plan because MHOS data is collected on managed care beneficiaries.

Materno-foetal leptin and insulin-like growth factor in low birth weight neonates

Low birth weight (LBW) is a health concern in developing countries. Leptin and insulin-like growth factor-I (IGF-I) are factors that influence LBW. A case-control study was conducted at Medani hospital, Sudan. Cases were women who had LBW deliveries ( 2,500 g) and controls were women with normal-weight babies ( 2.500 – 4,000 g). Sociodemographic and obstetrical characteristics were gathered from both groups and leptin and IGF-I levels were measured by ELISA. Cases and controls (45 in each arm) were matched in their basic data. The median (interquartile) of maternal leptin levels [9.9 (1.9 – 21.8) vs. 16.0 (9.6 – 20.8), ng/ml; P0.001] and IGF-I [1.6 (0.7 – 20.0) vs. 6.1 (4.3 – 7.1) ng/ml ; P 0.001] were significantly lower in cases than in controls. Likewise, cord serum leptin [5.8 (2.1 – 12.6) vs. 20.0 (5.1 – 37.8) ng/ml; P0.001] and cord serum IGF-I [1.7 (1.3 – 2.0) vs. 6.9 (5.9 – 7.4) ng/ml; P0.001] levels were significantly lower in cases than in controls. Significant positive correlation was found between birth weight and cord leptin ( r0.398), maternal ( r0.795) and cord ( r0.863) IGF-I levels. Maternal and cord leptin and IGF-I levels were significantly lower in LBW babies.

The use of multiplex PCR for the diagnosis of viral severe acute respiratory infection in children: a high rate of co-detection during the winter season

Respiratory tract infection is a major cause of hospitalization in children. Although most such infections are viral in origin, it is difficult to differentiate bacterial and viral infections, as the clinical symptoms are similar. Multiplex polymerase chain reaction (PCR) methods allow testing for multiple pathogens simultaneously and are, therefore, gaining interest. This prospective case-control study was conducted from October 2013 to February 2014. Nasopharyngeal (NP) and oropharyngeal (throat) swabs were obtained from children admitted with severe acute respiratory infection (SARI) at a tertiary hospital. A control group of 40 asymptomatic children was included. Testing for 16 viruses was done by real-time multiplex PCR. Multiplex PCR detected a viral pathogen in 159/177 (89.9 %) patients admitted with SARI. There was a high rate of co-infection (46.9 %). Dual detections were observed in 64 (36.2 %), triple detections in 17 (9.6 %), and quadruple detections in 2 (1.1 %) of 177 samples. Seventy-eight patients required intensive care unit (ICU) admission, of whom 28 (35.8 %) had co-infection with multiple viruses. AdV, HBoV, HRV, HEV, and HCoV-OC43 were also detected among asymptomatic children. This study confirms the high rate of detection of viral nucleic acids by multiplex PCR among hospitalized children admitted with SARI, as well as the high rate of co-detection of multiple viruses. AdV, HBoV, HRV, HEV, and HCoV-OC43 were also detected in asymptomatic children, resulting in challenges in clinical interpretation. Studies are required to provide quantitative conclusions that will facilitate clinical interpretation and application of the results in the clinical setting.

FOLFOX as Perioperative Chemotherapy of localized Gastric Cancer: Efficacy and Tolerance

BACKGROUND

Use of perioperative chemotherapy had significantly improved prognosis of localized gastric cancer. Two studies have validated this approach using cisplatin based chemotherapy despite important toxicities. We conducted this study with the aim to evaluate efficacy and toxicity of FOLFOX regimen in this setting.

MATERIAL AND METHODS

This is a retrospective study including patients followed for gastric cancer in the Oncology Department of the military hospital Mohamed V in Rabat, Morocco over a period of 7 years from 2007 to 2013. Patients received 4 cycles of mFOLFOX as perioperative regimen. Assessment of tumor response after completion of preoperative chemotherapy was granted by comparative CT scan, tumor markers measurements and R0 surgery rate.Adverse events were graded according to classification of the National Cancer Institute Common Toxicity Criteria version 4.0.

RESULTS

Thirty-one patients were included in this study. Use of preoperative chemotherapy showed partial response in fourteen patients (45.1%), stabilization in fifteen patients (48.4%). Tumor markers CEA and CA 19- 9 were significantly decreased. R0 resection rate was 83.87%. Only 2 (6.45%) cases of grade 3/4 hematologic toxicity were reported in our study. Achieving programmed postoperative chemotherapy was possible in 72.41% of patients.

CONCLUSIONS

Our study is limited by the retrospective design and small sample size but FOLFOX chemotherapy seems effective and well tolerated in this setting and its place deserves to be studied in a larger study.

Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida

To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.

Seasonal variation and hypertensive disorders of pregnancy in eastern Sudan

The aim of this study was to investigate the seasonal variation and hypertensive disorders of pregnancy in eastern Sudan, in the period between January 2008 and December 2010. The medical files of women attending at Kassala hospital, eastern Sudan with hypertension, with or without proteinuria were retrospectively retrieved. The data of patients with hypertensive disorders of pregnancy were compared with a similar number of controls that were normotensive and non-proteinuric. During the study period, there were 9,578 deliveries; 153 patients had hypertensive disorders of pregnancy, yielding an incidence rate of 1.6%. Of all cases and controls (306), there were 183 (59.8%) deliveries in winter, 84 (27.5%) in summer and 39 (12.7%) in autumn. The highest rate of pre-eclampsia was in winter (1.1%) (CI = 1.1-2.7, OR = 1.7, p = 0.004) and the lowest rate was in autumn (0.2%) (CI = 0.4-1.8, OR = 0.8, p = 0.758.). Our study revealed significant association between the incidence of hypertensive disorders of pregnancy and the winter season (103 (67.3%) vs 80 (52.3%), p = 0.001). Thus, more attention in the winter season might reduce the morbidity and mortality of hypertensive disorders of pregnancy.

Health insurance and breast-conserving surgery with radiation treatment

OBJECTIVES

To examine the impact of health insurance type on treatment of early-stage breast cancer using breast-conserving surgery (BCS) with radiation therapy (RT) among women in Florida and identify factors that contribute to the variations in receiving the treatment in women with the same health insurance type.

STUDY DESIGN AND METHODS

Breast cancer cases diagnosed during 1997 to 2002 were obtained from the Florida Cancer Data System. Women 40 years and older diagnosed with localized breast cancer were included. Demographic, insurance, and treatment information were extracted and linked with 2000 census data. χ² and multilevel logistic regression analyses were used.

RESULTS

A total of 33,706 women were diagnosed with localized breast cancer in Florida during 1997 to 2002. The average age of the women was 66 years, 58.62% had BCS while 38.61% had mastectomy, and only 2.77% had no surgical treatment. Type of health insurance plays a significant role in receiving BCS with RT. Furthermore, we found significant variations in the use of BCS with RT among women who have the same type health insurance by marital status, age, tumor size, year of diagnosis, level of education, and poverty level.

CONCLUSIONS

Although clinical practice guidelines recommend BCS with RT to treat women with localized breast cancer, significant differences in receiving the recommended treatment is found between and within types of health insurance. Identifying cultural barriers and educating the public about available treatment options are the major policy implications of this study. These observed differences require further study.

Bond durability of self-etch adhesive to ethanol-based chlorhexidine pretreated dentin after storage in artificial saliva and under intrapulpal pressure simulation

OBJECTIVE

To evaluate the bond strength durability of a single-step self-etch adhesive to dentin pretreated with either ethanol-based chlorhexidine (ECHX) or water-based chlorhexidine (WCHX) after storage in artificial saliva and under intrapulpal pressure simulation (IPPS).

METHODS

The occlusal enamel of 30 freshly extracted premolars was trimmed to expose midcoronal dentin. Roots were sectioned to expose the pulp chamber. Specimens were distributed over three groups (n=10) according to the dentin pretreatment used. In the first group, Adper Easy One (3M ESPE) was applied to the dentin surfaces according to the manufacturer's instructions (control group). In the second group, dentin was pretreated before bonding with 1 mL of 2% CHX diacetate dissolved in 100% ethanol (ECHX). The third group received the same pretreatment; however, CHX was dissolved in distilled water (WCHX). Pretreatment and bonding were carried out while the specimens were subjected to IPPS. Resin composite (Valux Plus, 3MESPE) buildups were made. After curing, specimens were stored in artificial saliva and under IPPS at 37°C in a specially constructed incubator (n=5/group) either for 24 hours or six months prior to testing. Thereafter, bonded specimens were sectioned into sticks with a cross section of 0.9 ± 0.01 mm(2) and subjected to microtensile bond strength (μTBS) testing (n=25/subgroup) using a universal testing machine. Data were statistically analyzed using two-way analysis of variance (ANOVA) with repeated measures, one-way ANOVA , and Bonferroni post hoc tests (p≤0.05). Failure modes were determined using a scanning electron microscope.

RESULTS

After 24 hours of storage, control and WCHX groups revealed significantly higher μTBS than the ECHX group. After six-month storage in artificial saliva and IPPS, only the WCHX group maintained its μTBS value. The predominant mode of failure was the mixed type, except for the ECHX group, which was mostly adhesive.

CONCLUSION

Pretreatment of the dentin with ECHX had a negative effect on bonding of the tested single-step self-etch adhesive; however, WCHX showed bond stability under IPPS.

Problems leading to conversion in laparoscopic cholecystectomy

In prospective study, the various reasons for conversion in laparoscopic cholecystectomy were shown and recommended various measures to decrease the incidence of conversion and associated complications with this procedure. Fifty cases of conversion in laparoscopic cholecystectomy were studied in Dhaka Medical College Hospital & Bangabandhu Sheikh Mujib Medical University from July 2002 to July 2004. The commonest cause of conversion was dense pericholecystic adhesion or unclear anatomy (24%). Next common cause was accidental injury to surrounding structures (18%) and uncontrolled bleeding (14%) and thick fibrosed gall bladder (14%). Other causes were gall bladder wall perforation (6%), carcinoma gall bladder (6%) and choledocholithiasis (6%), anatomic variation (4%), equipment failure (4%), cholecystoduodenal fistula (2%) and choledochal cyst (2%). Proper case selection, good laparoscopic skill and adequate experience of the surgeon are the prerequisites for safe laparoscopic cholecystectomy and thereby reducing conversion rate.

Construction of a comorbidity index for prostate cancer patients linking state cancer registry with inpatient and outpatient data

INTRODUCTION

Identifying clinically relevant comorbid conditions might lead to effective control of prostate cancer- specific risk factors and provide opportunities to improve patient care and outcomes. There are challenges in assessing comorbidity using linked databases such as statewide hospital administrative data and state cancer registry. The objective was to compile a comprehensive list of clinically relevant comorbid conditions for patients with prostate cancer using registry and statewide diagnosis databases.

METHODS

Florida Cancer Data System cases were linked with the inpatient/ outpatient diagnosis information. The Elixhauser Comorbidity Index was used as a reference. Conditions not captured by Elixhauser were identified, and grouped into clinically meaningful categories. Descriptive analysis was performed on comorbidity conditions and major study population variables. Associations of comorbidity with selected demographic and disease characteristics were examined.

RESULTS

Twenty-nine Elixhauser and 16 additional categories were examined within the 1 record per patient data set. Statistically significant association was found between comorbidity with race, stage, and age. Blacks had a higher mean number of conditions compared to whites. A higher proportion of blacks had at least 1 comorbid condition compared to whites. Additional conditions identified by this research capture more comorbidities for white men. Distinct trends towards larger number of comorbidities with older age at diagnosis and advanced disease stage were observed.

CONCLUSIONS

The Elixhauser Comorbidity Index captured the majority of comorbidities in the study population while the additional conditions identified by this research add more information. This study offers important insights into the challenges and process to identify relevant comorbidities for prostate cancer patients.

Use of treatment information from a state central cancer registry in prostate cancer research

A method was developed to categorize prostate cancer treatments for epidemiologic and outcomes studies. A total of 60,497 prostate cancer cases from the Florida Cancer Data System diagnosed between 2001 and 2007 were used. The classification has the following properties. First, the treatments classified in the same group are clinically comparable and capture all prostate cancer treatments or combinations of treatments (exhaustive classification). Second, the grouping was set up in a way that each patient is captured in only 1 treatment category without leaving out any patient due to treatment type (mutually exclusive categories). The prostate cancer cases were initially categorized into 14 combinations of treatment, which were then collapsed into 8 broader groups in order to maintain a large sample size for all groups, with treatments remaining clinically comparable within a group.

Association of positive thyroid auto antibodies with thyroid carcinoma

The association between thyroid autoimmunity and thyroid cancer was carried out in a series of solitary thyroid nodules submitted to fine-needle aspiration cytology and subsequent histopathology. US guided FNACs were obtained from 295 unselected consecutive patients with single thyroid nodules and positive (98) or negative (197) serum anti-thyroid antibody. Cytological results were classified in three classes of increased risk of malignancy: low risk (class II); indeterminate risk (class III); and suspect or malignant (class IV). A higher prevalence of class III (29.6%, p<0.05) and class IV (17.34%, p<0.05) and lower prevalence of class II (52.06%, p<0.01) were found in ATA+ nodules respectively. By multivariate logistic regression analysis ATA+ conferred a significant risk (odds ratio: 1.97 & 95% confidence interval: 0.97-3.97) for class IV cytology independently for age and sex. In 53 patients where thyroidectomy was carried out, thyroid cancer was found in (86.66%) patients with class IV nodules, in (19.4%) of class III nodules (all ATA-) and in none of 7 class II nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (13.2%) of ATA+, when compared with ATA- nodules (8.1%, p>0.01), but the significance of this finding is limited by the low number of class II nodules operated on. The presence of ATA+ confers an increased risk of suspicious or malignant cytology in solitary thyroid nodules.

High incidence of obstetric complications in Kassala Hospital, Eastern Sudan

Medical files of women delivered at Kassala Hospital, Eastern Sudan in the period of January-December 2009 were reviewed retrospectively. Out of 4,689 delivered women, 14.7% were teenagers, 67.1% had no antenatal care and 12.6% were grandmultiparous. Obstetric complications included: pre-term birth (2.6%); pre-eclampsia/eclampsia (4.2%); haemorrhage (2.9%); malpresentation (5.5%); obstructed labour (1.9%) and ruptured uterus (0.6%). Caesarean delivery rate was 31.1%. While 89.4% of the newborn babies were taken home, 6% were admitted to the nursery, 4.4% were stillbirths, and 0.2% immediate neonatal deaths. There were 26 maternal deaths (550 per 100,000 live births), mainly due to septicaemia (38.4%), haemorrhage (19.2%), embolism (15.3%) and malaria (11.5%). Thus, there is a high frequency of maternal morbidities and mortality which needs improvement in obstetric care. It is important to make visits from a tertiary hospital to the region to collect statistics and discuss management of the problems they reveal, with the local staff.

Acute abdomen 10 years after surgery for duodenal ulcer disease

A 55 years old male was admitted in the surgical unit of Dhaka Medical College & Hospital with the complaints of pain and discomfort in the upper abdomen for 1 day and hiccough and vomiting for several episodes for same duration. He had history of abdominal operation 10 years back for his peptic ulcer disease probably due to pyloric stenosis. On examination a linear scar mark was present along the upper midline region & visible peristalsis was seen on the left hypochondriac region. A palpable diffuse lump was present in the left hypochondriac region which was intraperitoneal seemed to be distended gut and the peristaltic wave moved from left to right. Endoscopy of upper GIT Showed loops of small intestine (evidenced by valvulae conneventes) protruded through a stoma suggestive of jejunogastric intussusception. Laparotomy revealed a portion of adherent small gut already become gangrenous so the whole portion of the intussuscepted gut was resected. After that revision and take-down of the anastomosis was done with vicryl stitches. The post operative period was uneventful. The patient underwent regular follow up.

Hearts from DCD donors display acceptable biventricular function after heart transplantation in pigs

Cardiac transplantation is in decline, in contrast to other solid organs where the number of solid organ transplants from donors after circulatory death (DCD) is increasing. Hearts from DCD donors are not currently utilized due to concerns that they may suffer irreversible cardiac injury with resultant poor graft function. Using a large animal model, we tested the hypothesis that hearts from DCD donors would be suitable for transplantation. Donor pigs were subjected to hypoxic cardiac arrest (DCD) followed by 15 min of warm ischemia and resuscitation on cardiopulmonary bypass, or brainstem death (BSD) via intracerebral balloon inflation. Cardiac function was assessed through load-independent measures and magnetic resonance imaging and spectroscopy. After resuscitation, DCD hearts had near normal contractility, although stroke volume was reduced, comparable to BSD hearts. DCD hearts had a significant decline in phosphocreatine and increase in inorganic phosphate during the hypoxic period, with a return to baseline levels after reperfusion. After transplantation, cardiac function was comparable between BSD and DCD groups. Therefore, in a large animal model, the DCD heart maintains viability and recovers function similar to that of the BSD heart and may be suitable for clinical transplantation. Further study is warranted on optimal reperfusion strategies.

Polymorphisms of the SLC11A1 gene and resistance to bovine tuberculosis in African Zebu cattle

Bovine tuberculosis (BTB) is a considerable health threat to livestock keepers and general communities in many developing countries. Information on genetic resistance or susceptibility because of polymorphisms of candidate genes could be used in making selection decisions for breeding disease tolerant/resistant animals. Here, we investigated associations between polymorphisms at the solute carrier family 11 (proton-coupled divalent metal ion transporters), member 1 gene (SLC11A1, previously known as natural resistant associated macrophage protein 1, NRAMP1), with BTB phenotypes in Chadian cattle. Phenotypes were (i) single intradermal comparative cervical tuberculin test (SICCT) outcome, (ii) presence of gross visible lung lesions, (iii) a bacteriological culture test outcome and (iv) a predicted true BTB infection status using a Bayesian model. All traits were recorded as binary (presence or absence) traits. A total of 211 cattle were genotyped for a microsatellite within the SLC11A1 candidate gene. Standard linear and threshold-liability models regressing BTB traits on copy number of SLC11A1 alleles revealed statistically significant effects of SLC11A1 alleles (P < 0.001) on most BTB traits. Polymorphisms (alleles 211, 215 and 217) are significantly related to lower incidence of BTB traits in Chadian cattle. This is the first study to report the association of SLC11A1 gene polymorphisms with BTB traits in Chadian or any other African cattle breeds.

Synthesis and spectral characterization of CoxMg1-xAl2O4 as new nano-coloring agent of ceramic pigment

New nano-blue ceramic pigments of Co(x)Mg(1-x)Al(2)O(4) (0< or =x< or =0.1) have been prepared by co-precipitate-combustion as a hybrid method using urea as a fuel at 500 degrees C in open furnace in air atmosphere. The structure of pigment is assigned based on TGA/DTA/DrTGA analyses, X-ray diffraction (XRD) and transmission electron microscopy (TEM). Also, electronic spectra, infrared (IR) and diffuse reflectance spectroscopy (DRS) using CIE L*a*b* parameter measurement techniques were used. The results revealed that the nano-particle size of pigments were obtained in the range 30-38 nm as well as the varying colors and particle size as a result of different calcinations temperatures within the range of 500-1200 degrees C for 2h.

Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital

A cross-sectional hospital-based study was carried out at Tikrit teaching hospital, Iraq, from October 2004 to September 2005, to identify the prevalence and etiology of nosocomial infectious diarrhoea among children under 5 years of age. Of 259 children admitted to the paediatric ward for reasons other than diarrhoea and hospitalized for more than 3 days, clinical and laboratory analysis of stool samples showed nosocomial diarrhoea in 84 children (32.4%). The most common causative agents were enteropathogenic Escherichia coli (25.9%), Clostridium difficile (21.0%) and rotavirus (18.5%). Single infectious agents caused 63.1% of the cases, while mixed infections were detected in 16.7%; in 20.2% of children the cause remained unknown.

Patient with bilateral breast enlargement and hypospadias

A 20 year old man was admitted in the surgical unit of Dhaka Medical College Hospital on August 2007 presented with Hypospadias & underdeveloped penis from childhood, gradual enlargement of both breasts for the last 10 years, absence of axillary and pubic hair from puberty & painful swelling of both testes for the last 3 years. The patient was regarded as a female upto the age of 10 years. He has got no voice change since puberty. On examination he had average body built, there was bilateral gynaecomastia, hypospadias, rudimentary penis & absence of pubic and axillary hair. His testosterone level, serum prolactin level, serum progesterone level, serum estradiol level was done. Cytology on buccal smear done and ultrasonography revealed no ovary and uterus. Ultimately patient was diagnosed as a case of androgen insensitivity syndrome (AIS). The case is reported for clinical awareness & to share our experience.

Synthesis and characterization of new nano-particles as blue ceramic pigment

The synthesis of a new nano-blue ceramic pigment CoxMg1-xAl2O4 (0 < or = x < or = 0.1) using the combination between co-precipitation and combustion synthesis (CS) method. The structure of pigments is assigned based on thermogravimetric and differential thermogravimetric analysis (TG-DTGA), X-ray diffractions (XRD), and UV-vis spectroscopy. Also, diffuse reflectance spectroscopy (DRS) using CIE L*a*b* parameter measurement method, infrared spectroscopy (IR) and transmission electron microscopy (TEM) is used. The result revealed that the nano-size particle pigment was obtained in range 24-35 nm by using 3-methyl-pyrozole-5-one (3MP5O) as a fuel at 400 degrees C in open furnace. Also, results show the varying colors and particles' size as a result of different calcination temperatures from 500 to 1200 degrees C for 2h.