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QALY league table of Iran: a practical method for better resource allocation
Full text linkBackground: The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. Methods: A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. Results: In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45 of the reviewed studies. Discount rates ranged from zero to 7.2. The cost per QALY ranged from 0.144 in radiography costs for patients with some orthopedic problems to 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. Conclusions: However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran. © 2021, The Author(s)
Therapeutic role of enoxaparin in intra-uterine growth restriction: A randomized clinical trial
No full textObjective: Intrauterine growth restriction is a leading cause of perinatal mortality and morbidity. Using enoxaparin may enhance the placental circulation and improve the intrauterine growth. This study was conducted to assess the efficacy and safety of enoxaparin in treatment of intra-uterine growth restriction. Study design: 125 women with intrauterine growth restriction were randomized to control group and intervention group (receiving routine high risk pregnancy prenatal care plus daily subcutaneous injection of 40 mg enoxaparin). Prolongation of pregnancy, fetal birth weight, fetal outcome and enoxaparin side effects were compared in 2 groups. Results: Baseline characteristics were similar in 2 groups. Mean gestational age at delivery was 36.73(±2.71) in enoxaparin group and 36.85(±2.17) in control group which showed no statistically significant difference. Mean fetal birth weight had also no statistically significant difference in enoxaparin and control group (2370.16 ± 580.72 g versus 2456.07 ± 543.06 g). Rate of betamethasone administration, intubation, NICU admission, sepsis, necrotizing enterocolitis, intra-ventricular hemorrhage, hypoglycemia and low apgar score were similar in two groups. No major adverse effect was seen. Conclusion: Enoxaparin did not prolong the pregnancy and fetal birth weight and did not improve the fetal outcome even in patients with impaired baseline Doppler findings. © 2021 Elsevier Masson SA
Typical chest CT features can determine the severity of COVID-19: A systematic review and meta-analysis of the observational studies
Full text linkBackground: It remains unclear whether a specific chest CT characteristic is associated with the clinical severity of COVID-19. This meta-analysis was performed to assess the relationship between different chest CT features and severity of clinical presentation in COVID-19. Methods: PubMed, Embase, Scopus, web of science databases (WOS), Cochrane library, and Google scholar were searched up to May 19, 2020 for observational studies that assessed the relationship of different chest CT manifestations and the severity of clinical presentation in COVID-19 infection. Risk of bias assessment was evaluated applying the Newcastle-Ottawa Scale. A random-effects model or fixed-effects model, as appropriately, were used to pool results. Heterogeneity was assessed using Forest plot, Cochran's Q test, and I2. Publication bias was assessed applying Egger's test. Results: A total of 18 studies involving 3323 patients were included. Bronchial wall thickening (OR 11.64, 95 CI 1.81�74.66) was more likely to be associated with severe cases of COVID-19 infection, followed by crazy paving (OR 7.60, 95 CI 3.82�15.14), linear opacity (OR 3.27, 95 CI 1.10�9.70), and GGO (OR 1.37, 95 CI 1.08�1.73). However, there was no significant association between the presence of consolidation and severity of clinical presentation (OR 2.33, 95 CI 0.85�6.36). Considering the lesion distribution bilateral lung involvement was more frequently associated with severe clinical presentation (OR 3.44, 95 CI 1.74�6.79). Conclusions: Our meta-analysis of observational studies indicates some specific chest CT features are associated with clinical severity of COVID-19. © 202
Economic Burden of Stroke in Iran: A Population-Based Study
Full text linkObjectives: This study was conducted to estimate the annual societal costs in Iran associated with the treatment of ischemic and hemorrhagic stroke patients using a prevalence-based cost-of-illness framework. Methods: A prevalence-based cost-of-illness framework was applied. Key model parameters included annual incidence of stroke; use of stroke therapies, medicines, and other medical care resources; work days missed; wage rates; and annual costs per patient. The outcomes measured were total societal costs, societal cost per year, and societal cost per patient-year. Results: For the studied 1940 patients, the economic burden of stroke in 2018 was roughly 4 081 124 in US dollars. Bearing in mind that there are about 100 000 cases of stroke, including new (35) and old cases (65) of 2 types of strokes, per year in Iran, the estimated economic impact is about 368 925 000. Lodging, medication, and consumables account for 69 of all direct medical costs (299 959). The main cost factors were mortality costs (76.6) and disability costs (14.7). Conclusion: The economic impact of stroke in Iran is considerable. The premature deaths and resulting disability from strokes accounted for the main productivity losses and all societal costs of stroke (approximately 91 of all costs). To control hypertension and decrease the burden of stroke, especially in elderly age groups, it is recommended that Iran look into how to focus on and expand healthy lifestyle choices. © 2020 ISPOR�The professional society for health economics and outcomes researc
Social and Economic Costs and Health-Related Quality of Life in Patients With Acute Coronary Syndrome
No full textObjectives: Health-related quality of life (HRQOL) evaluation is an important measure of the impact of certain inerventions, epecially coronary artery diseases treatments. As more patients with acute coronary syndrome (ACS) live longer, doctors and researchers want to know how they manage in day-to-day life. The aim of this study was to compare costs and HRQOL of patients who underwent percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical therapy (MT) and to assess its main determinants in the whole sample of patients with ACS for a period of 12 months. Methods: The study was carried out to estimate costs and HRQOL evaluation of 310 patients who underwent coronary revascularization (PCI, n = 139; CABG, n = 128; and MT, n = 43). We estimated direct costs (medical costs and nonmedical costs) and indirect costs (productivity losses owing to morbidity and mortality) based on a societal perspective, and HRQOL was assessed using the EQ-5D-3L (5 dimensions and 3 levels) and visual analog scale (VAS). We applied costs and HRQOL 1 month before treatment and 12 months after treatment in 3 groups, and scores were compared. Data entry and analysis were performed with SPSS. Results: Total EQ-5D index scores in PCI, CABG, and MT groups 1 month before treatment were 0.54 ± 0.26, 0.52 ± 0.25, and 0.56 ± 0.25, respectively. After 12 months, the HRQOL mean changed to 0.67 ± 0.20, 0.74 ± 0.15, and 0.65 ± 0.19, respectively, in PCI, CABG, and MT groups. The mean EQ-5D VAS score 1 month before treatment was 63 ± 15.4 for the PCI group, 62 ± 16.4 for the CABG group, and 64 ± 18.4 for the MT group; the mean EQ-5D VAS score 12 months after treatment was 74.8 ± 19.5 for the PCI group, 78.8 ± 18 for the CABG group, and 74 ± 19.7 for the MT group. All the 3 therapeutic strategies presented significant improvement in all dimensions of the follow-up. However, the CABG group was the one that had significantly greater improvement compared with PCI and MT. The mean (95 confidence interval) annual total cost for the overall sample was found to be 4940/patient. This cost was significantly higher among patients with CABG (7327/patient) compared with PCI (5225/patient) and MT (2278/patient). Direct costs accounted for 87.7 and indirect costs for 12.3 of the total costs. Conclusion: The quality of life was better in both CABG and PCI groups compared with MT after 1 year of follow-up. However, treatment with CABG is more difficult and expensive than PCI and MT, but it provides a better quality of life. The findings of the present study indicate the high economic burden of ACS in Iran. © 202
Association between noise annoyance and socioeconomic status of the employees in an electrical panel manufacturer
No full textNoise is considered as one of the most influential physical factors in working environments. The advancement of industries has made it a threat to the physical and mental health of individuals on a global scale. Over the past twenty years, there has been strong evidence of a relation between the impact of external factors, lifestyle, and socioeconomic status. The present research aimed to investigate the association between noise annoyance and the socioeconomic status of the employees in an electrical panel manufacturer. At the first stage, initial visits and a survey of the factory were carried out. At the next stage, the noise level the workers were exposed to was measured using a dosimetry method. Then, the annoyance and socioeconomic status questionnaires were distributed among the employees. Having been collected, the questionnaires were ranked and the data were analyzed using the SPSS software. The results showed that there was a significant relationship between noise exposure and annoyance level, and between annoyance and socioeconomic status of the workers. © 202
Bilateral striatal transplantation of human olfactory stem cells ameliorates motor function, prevents necroptosis-induced cell death and improves striatal volume in the rat model of Huntington's disease
No full textCellular transplant therapy is one of the most common therapeutic strategies used to mitigate symptoms of neurodegenerative diseases such as Huntington's disease (HD). Briefly, the main goal of the present study was to investigate HD's motor deficits through the olfactory ecto-mesenchymals stem cells (OE-MSC) secretome. OE-MSCs were characterized immunophenotypically by the positive expression of CD73, CD90 and CD105. Also, three specific markers of OE-MSCs were obtained from the nasal cavity of human volunteers. The main features of OE-MSCs are their high proliferation, ease of harvesting and growth factor secretion. All animals were randomly assigned to three groups: control, 3-NP + vehicle treated and 3-NP + Cell groups. In both experimental groups, the subjects received intraperitoneal 3-NP (30 mg/kg) injections once a day for five consecutive days, followed by the bilateral intra-striatal implantation of OE-MSCs in the 3-NP + Cell group. Muscular function was assessed by electromyography and rotarod test, and the locomotor function was evaluated using the open field test. According to our findings, striatal transplants of OE-MSCs reduced microglial inflammatory factor, the tumor necrosis factor (TNFα) in the 3-NP + Cell group, with a significant reduction in RIP3, the markers of necroptosis in striatum. In addition to the remarkable recovery of the striatal volume after engraftment, the motor activities were enhanced in the 3-NP + cell group compared to the 3-NP + vehicle group. Taken together, our results demonstrated the in vivo advantages of OE-MSCs treatment in an HD rat model with numerous positive paracrine effects including behavioral and anatomical recovery. © 2020 Elsevier B.V
Intravenous injection of apelin-13 improves sensory-motor balance deficits caused by cerebral ischemic reperfusion injury in male wistar rats via restoration of nitric oxide
No full textIt has been reported that apelin-13 possesses neuroprotective effects against cerebral ischemia/reperfusion injury (IRI). Disabilities in sense, movement and balance are the major stroke complications which, result in a high rate of mortality. Here, effects of intravenous (IV) injection of apelin-13 on the severity of neural death, infarct volume, neurological defects and its association with nitric oxide (NO) were investigated. A rat model of cerebral IRI was created by middle cerebral artery occlusion (MCAO) for 60 min and restoration of blood flow for 23 h. Animals were randomly assigned into six groups: sham, ischemia (MCAO), vehicle (MCAO + PBS) and three treatment groups (MCAO + apelin-13 in 10, 20, 40 μg/kg doses, IV). All injections were carried out via tail vein injection 5 min before reperfusion. Neural loss and infarct volume were evaluated by Nissl and 2,3,5-triphenyltetrazolium chloride (TTC) staining, respectively. Neurological defects were scored by standard modified criteria. Serum NO was measured by colorimetric method. Apelin-13 in doses of 20 and 40 μg/kg significantly reduced neural death, infarct volume and disturbance of sensory-motor balance compared to control and vehicle groups (p < 0.05). Serum NO levels reduced in MCAO groups compared to sham. Apelin-13 restored serum NO levels at 20 μg/kg dose (p < 0.05). Our data showed beneficial effect of IV injection of apelin-13 on sensory-motor balance defects by reducing neural death and restoration of serum NO levels. The present study shows the validity of apelin-13 in treatment of ischemic stroke in different administration methods. © 202
Preparation of internally-crosslinked alginate microspheres: Optimization of process parameters and study of pH-responsive behaviors
No full textIn this study, the effects of various parameters of the water-in-oil emulsification/internal gelation method on the properties of calcium-alginate microparticles were evaluated and optimized. Results showed that the spherical-shaped microparticles with the highest circularity and high production yield can be produced by alginate solution with a concentration of 2 wt., calcium carbonate/alginate ratio of 10/1 (w/w), water/oil volume ratio of 1/20, emulsifier concentration of 5 (v/v), and emulsification speed of 1000 rpm. Two model drugs including simvastatin lactone and simvastatin β-hydroxyacid were loaded into the microspheres with promising encapsulation efficiencies of 73 and 69 , respectively. The microspheres showed a pH-responsive swelling behavior with a percentage of 10.60 , 352.65 , 690.03 , and 1211.46 at the pH values of 2.0, 4.5, 7.4, and 8.5, respectively. The microspheres showed an increasing trend of release rate in direct proportion to pH. These findings would be useful for therapeutic applications which need pH-responsive drug carriers. © 2020 Elsevier Lt
An overview of Betacoronaviruses-associated severe respiratory syndromes, focusing on sex-type-specific immune responses
Full text linkEmerging beta-coronaviruses (β-CoVs), including Severe Acute Respiratory Syndrome CoV-1 (SARS-CoV-1), Middle East Respiratory Syndrome-CoV (MERS-CoV), and Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2, the cause of COVID19) are responsible for acute respiratory illnesses in human. The epidemiological features of the SARS, MERS, and new COVID-19 have revealed sex-dependent variations in the infection, frequency, treatment, and fatality rates of these syndromes. Females are likely less susceptible to viral infections, perhaps due to their steroid hormone levels, the impact of X-linked genes, and the sex-based immune responses. Although mostly inactive, the X chromosome makes the female's immune system more robust. The extra immune-regulatory genes of the X chromosome are associated with lower levels of viral load and decreased infection rate. Moreover, a higher titer of the antibodies and their longer blood circulation half-life are involved in a more durable immune protection in females. The activation rate of the immune cells and the production of TLR7 and IFN are more prominent in females. Although the bi-allelic expression of the immune regulatory genes can sometimes lead to autoimmune reactions, the higher titer of TLR7 in females is further associated with a stronger anti-viral immune response. Considering these sex-related differences and the similarities between the SARS, MERS, and COVID-19, we will discuss them in immune responses against the β-CoVs-associated syndromes. We aim to provide information on sex-based disease susceptibility and response. A better understanding of the evasion strategies of pathogens and the host immune responses can provide worthful insights into immunotherapy, and vaccine development approaches. © 2021 Elsevier B.V