A projection of the impact of lipid-lowering therapy on high-risk employee disability and medical costs

OBJECTIVE: The objective of this study was to examine the impact of introducing rosuvastatin calcium on direct and indirect costs among patients at high risk for coronary heart disease. METHODS: An economic simulation model was developed to project the number of cardiovascular events and associated direct and indirect costs under varying treatment scenarios. RESULTS: In an average-sized commercial health plan with 210,000 covered lives and 9,336 high-risk patients, an uptake of rosuvastatin by 11% of high-risk patients would result in eight fewer cardiovascular events, a net savings of 0.85 million dollars in direct medical costs and a net savings of 36,404 dollars in productivity loss over a period of 5 years. The overall reduction in total costs is equivalent to 1735 dollars per rosuvastatin-treated patient. CONCLUSIONS: At current statin prices, the use of rosuvastatin could lead to fewer cardiovascular events and lower direct and indirect costs.     

Disseminated Mycobacterium bovis infection after BCG vaccination

The Calmette-Güerin vaccine (BCG) is administered to all the newborns in Iran in order to prevent tuberculosis. Complications of this vaccine are uncommon. We report disseminated BCG disease in 17 patients less than 10 years old. This is a retrospective study of total of 17 cases who were admitted in Children Medical Center Hospital with systemic syndrome compatible with Mycobacterium disease with evidence of histopathologic demonstration of acid-fast bacilli during 1995-2004. Fourteen cases occurred in children younger than 1 year old. Nine patients were female. Ten of the 17 total cases were associated with an immune deficiency including severe combined immunodeficiency, chronic granulomatous disease and cell mediated immune defect. Response to therapy was ineffective and 10 of them (58.8%) died. Disseminated BCG disease is an uncommon but devastating complication of vaccination that should be considered in the appropriate clinical setting. Immune-compromised infants are at greatest risk and they respond poorly to standard therapies.     

Low grade endometrial stromal sarcoma of uterine: review of 17 cases

Endometrial stromal sarcomas (ESS) are the second most common uterine sarcomas. Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. Uterine sarcomas most often affect postmenopausal women. The aim of this retrospective study was to review the experience in the treatment and clinical outcome of low grade malignant endometrial stromal sarcoma. Seventeen patients with histologically proven low grade ESS in department of Gynecologic Oncology of the Vali-e-Asr Hospital, Tehran-Iran, between 1999 and 2008 were included in the analysis. Demographics, pathology, treatment, time to recurrence, salvage therapy and survival information was collected. The median age of our patients was 45.35 ± 6.8 (range 36-61). The median parity of the patients was 5 (range 0-8). Most patients were diagnosed at FIGO stage I. The mean survival for patients with stage I and II was 73.5 ± 35.09 and 57.6 ± 5.37 months, respectively, with mortality rate of 5.9% through a median follow-up time of 68.82 ± 30 months. Of 17 patients, seven cases (35.29%) were disease free at 6 years after hysterectomy. Radiotherapy was administered to four patients (23.53%). Only one patient recurred at 10th month after surgery. Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those sparing ovarian function.     

Effects of hypoglycemia on health-related quality of life, treatment satisfaction and healthcare resource utilization in patients with type 2 diabetes mellitus

Aims

We sought to examine the acculturation level and its relationship with diabetes self-management among Chinese Americans with type 2 diabetes.

Methods

We conducted a cross-sectional survey research study in a convenience sample of 211 Chinese Americans with type 2 diabetes. We measured acculturation and diabetes self-management and evaluated the association between acculturation and self-management behaviors after controlling participants’ characteristics using structural equation modeling.

Results

The majority of the participants was born outside the U.S. and had a low level of acculturation. Women and older individuals were less acculturated, and those who had higher social economic status and lived in the U.S. for a longer period were more acculturated. The results of the structural equation modeling demonstrated that acculturation was significantly associated with DM self-management, and more-acculturated individuals were more likely to perform DM self-management than less-acculturated ones after controlling demographic characteristics.

Conclusions

The results of this study indicated that Chinese Americans diagnosed with diabetes may benefit from acculturation to mainstream society probably because increased acculturation was associated with increased help seeking behaviors and increased use of professional services.     

RETRACTED ARTICLE: Evaluation of mRNA expression levels of IL-17A and IL-10 cytokines in cervical cancer

In this study, we evaluated mRNA expression levels of interleukin (IL)-10/IL-17A by quantitative real-time PCR and their clinical importance in cervical cancer. The IL-10 mRNA levels were higher in cervical cancer tissues as compared with corresponding normal tissues (p?<?0.05). Moreover, IL-17A mRNA was significantly increased in cervical cancer tissues than in normal tissues (p?<?0.05). Moreover, the high expression level of IL-10 mRNA was markedly related to International League of Gynecology and Obstetrics (FIGO) stage (p?=?0.001), but no significant association was found with other clinical factors including age, tumor size, histological grades, and lymph node metastasis. Moreover, high expression levels of IL-17A were not associated with patients’ age, tumor size, FIGO stage, and histological grades while IL-17A expression was strongly linked to lymphatic metastasis (p?=?0.001). These findings showed that IL-17A might have a crucial role in cervical cancer metastasis. Taken together, IL-17A expression was strongly linked to lymphatic metastasis, indicating that IL-17A might have a crucial role in cervical cancer metastasis. Moreover, our study suggested the association of IL-10 mRNA expression with clinical stage.     

The DEC-net European register of paediatric drug therapy trials: contents and context

Objective To describe the results and conclusions of DEC-net, an international, publicly available register of paediatric drug therapy clinical trials, and to assess which paediatric health areas are covered by research and by which trial types. Methods The contents of the register, which was set up by four groups (Italy, UK, France, Spain) who searched for paediatric trials and collected data between 2004–2006, were analysed. The disease areas reflected were compared with those covered by published trials and Burden of Disease (BD) data. Results In all, 257 trial records were analysed, 86 of which were entered by the Italian partner, 84 by the UK partner, 56 by the French partner and 31 by the Spanish partner. Spain entered the majority of multinational trials, while the UK had the majority of single-centre national trials. Most trials were experimental (79%), and the most commonly represented diseases were neoplasms (14% trials). In all, 28% were double-blind randomised controlled trials (RCTs). The most common disease areas addressed in the 257 trials were similar to the published trials’ areas. In contrast, the primary research area was low on the BD list. Conclusions DEC-net has demonstrated that international research efforts exist, even for paediatrics, although there may be an imbalance between national and multinational studies and a limited approach to double-blind RCTs. Recent initiatives will increase the number of children participating in research, and European legislation will require prospective registration. Paediatric research priorities must be better defined, however, and this can be done by registering research and making the information available to all relevant actors.     

The nonadrenergic noncholinergic-mediated relaxation of corpus cavernosum was impaired in chronic lithium-treated rats: improvement with l-arginine

One-third of lithium-treated men complain from sexual dysfunction, although the exact mechanisms of which are not yet known. In this study we investigated the effect of chronic lithium (LiCl, 600 mg/l for 30 days) administration on the neurogenic relaxation of isolated rat corpus cavernosum. The corporal strips were precontracted with phenylephrine and electrical field stimulation (EFS) was applied to obtain relaxation. Relaxation to EFS was significantly (P<0.001) impaired in LiCl-treated rats. The nitric oxide (NO) synthase inhibitor Nomega-nitro-l-arginine methyl ester (l-NAME; 100 microM) inhibited the relaxation to EFS in both LiCl-treated and control rats. The NO precursor l-arginine, at per se noneffective concentration (0.1 mM), significantly (P<0.001) enhanced the EFS-induced relaxation of LiCl-treated corporal strips. The relaxation responses to the NO donor sodium nitroprusside were similar between two groups. These data demonstrate that chronic lithium treatment could impair the NO-mediated neurogenic relaxation of rat corpus cavernosum which could be prevented by l-arginine.