scholarly journals Current Status of Low Dose Overnight Dexamethasone Supression Test (LODST)

2020 ◽  
pp. 5-8
Author(s):  
Tofail Ahmed ◽  
Hajera Mahtab ◽  
Tania Tofail ◽  
AHG Morshed ◽  
Fatema B Rahman ◽  
...  
Keyword(s):  
Low Dose ◽  
Silent Period ◽  
Cost Effective ◽  
Outcome Data ◽  
Management Policy ◽  
Current Status ◽  
Age Group ◽  
Biochemical Tests ◽  
Risk Association

Introduction: Low Dose Overnight Dexamethasone Supression Test (LODST) is a diagnostic tool for spontaneous Cushing’s Syndrome (CS). A LODST negative excludes CS. But there are 2 exceptions - testing during silent period of Cyclic Cushing’s Disease (CD) or a false negativity by one mg dexamethasone in mild CD. Method: We analyzed age and sex data of 154 LOSDT to see their risk association for CS. Result: The detection rate of CS by LOSDT is 26% and with Cortisol (211.27 to 373.69 nmol/L as 95% CI). Among the cases, 29.2% are pediatric and 70.8% are female. CS group do not differ from rest in sex and age group distributions (sig.> 136) but CS is older group with a mean difference of 2.46 - 13.31 years (sig 005). Logistic equation documented CS is a different population (sig 000) and which is influence by their age (sig 021) but not by sex or age group (sig > 743). Therefore, age is an independent risk factor for CS. Conclusion: We opine to use LODST as the first tool for CS. And LODST negative cases to be evaluated by newer imaging and biochemical tests. Only in imaging positive are to be managed as per guideline(s) for incidentaloma. Both negative cases are to be enrolled in follow up if age > 30 years or symptoms score suggest CD and rest are to be excluded. Cumulative diagnostic and outcome data will then may be used to formulate cost-effective management policy for CS.

scholarly journals One Year of Hepatitis B Immunoglobulin Plus Tenofovir Therapy is Safe and Effective in Preventing Recurrent Hepatitis B Infection Post-Liver Transplantation

2014 ◽  
Vol 28 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Tomohiro Tanaka ◽  
Eberhard L Renner ◽  
Nazia Selzner ◽  
George Therapondos ◽  
Leslie B Lilly
Keyword(s):  
Liver Transplantation ◽  
Hepatitis B ◽  
Low Dose ◽  
Cost Effective ◽  
Hbv Infection ◽  
Recurrent Hepatitis ◽  
Hepatitis B Immunoglobulin ◽  
One Year ◽  
Related Liver Disease

BACKGROUND: Hepatitis B immunoglobulin (HBIG) given in combination with a nucleos(t)ide analogue has reduced the rate of recurrent hepatitis B virus (HBV) infection following liver transplantation (LT); however, the most effective protocol remains unclear.OBJECTIVE: To evaluate the use of tenofovir disoproxil fumarate (TDF) in combination with one year of low-dose HBIG.METHODS: Twenty-four adults who underwent LT for HBV-related liver disease at the University Health Network (Toronto, Ontario) and received TDF (± lamivudine) and one year of HBIG to prevent recurrent HBV infection from June 2005 to June 2011 were evaluated.RESULTS: The median length of follow-up post-LT was 29.1 months. Three patients died during the follow-up period. Patient survival was 100% and 84.1% at one and five years, respectively. None of the patients developed recurrent HBV infection. No significant adverse event was observed due to TDF administration; renal function pre- and post-LT were also acceptably preserved.CONCLUSION: The present study demonstrated that a short, finite course of low-dose HBIG combined with maintenance of long-term TDF staring before LT is cost-effective and safe. However, further prospective study involving a larger patient cohort with a longer followup period is required to confirm the results.

Abstract 073: Maximizing Sacubitril/Valsartan Clinical Benefit Under Budget Constraints

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ronen Arbel ◽  
Ariel Hammerman ◽  
Noa Triki ◽  
Jean Marc Weinstein ◽  
Dan Grrenberg
Keyword(s):  
Cost Effective ◽  
Outcome Data ◽  
Budget Constraints ◽  
Healthcare Settings ◽  
Neprilysin Inhibitor ◽  
Prior Use ◽  
Trial Treatment ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
The Cost

Background: The angiotensin receptor-neprilysin inhibitor sacubitril/valsartan has been shown in the PARADIGM-HF trial to be superior to enalapril in reducing the risks of cardiovascular (CV) deaths and hospitalizations in heart failure (HF) patients. Although several studies suggested that sacubitril/valsartan is a cost-effective therapy, budget constraints may limit its use. Our objective was to characterize HF sub-populations in which cost per CV death/hospitalization prevented are excessively high in order to assist in treatment prioritization decisions. Methods: Outcome data were retrieved from the published PARADIGM-HF trial reports. Costs were calculated based on current United States prices of sacubitril/valsartan. Results: In the PARADIGM-HF trial, treatment of 4,187 patients with sacubitril/valsartan resulted in prevention of 203 CV deaths or HF hospitalizations (135 CV deaths) during a total of 9,396 patient-years. The estimated additional cost of sacubitril/valsartan during the trial’s follow-up period would have reached $42,089,220. Therefore, the cost of preventing one HF hospitalization or CV death would have been $207,336 and the cost of preventing one CV death would have been $311,772. This figure is significantly higher in sub-groups that presented a lower risk-reduction, as in patients with an ejection fraction >35% ($674,831) and in patients without prior use of HF medical therapy ($2,024,494). Conclusions: In healthcare settings under budget constraints, payers can maximize clinical outcomes in HF patients, by prioritizing sacubitril/valsartan therapy to sub-populations that have demonstrated higher benefit in the PARADIGM-HF trial. Advocating the reduction of sacubitril/valsartan prices could enable wider populations to benefit from this promising therapy.

scholarly journals Effect of Apamarga Kshara Taila Uttarbasti in the Management of Infertility w.s.r. Tubal-blockage

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Rajput Shivshankar A ◽  
Mata Shweta ◽  
Dei L P ◽  
Donga S B ◽  
Shaikh Nilofar
Keyword(s):  
Cost Effective ◽  
Age Group ◽  
Pelvic Infection ◽  
Tubal Infertility ◽  
Tubal Blockage ◽  
Ayurvedic Treatment ◽  
Selection Of Patients ◽  
Criteria For Selection ◽  
Selection Of

Infertility is the most sensitive and cumbersome problem which haunts every couple. The major cause in infertility is female factor which is 30.20%. Among female factor the sub factors are ovarian, tubal, endometrial and uterine. Female Infertility due to tubal blockage is the 2nd most contributing factor, in 30% of the cases. So for this study, we considered only tubal infertility and to make a pin-pointed assessment criteria. The criteria for selection of patients and assessment of results were unilateral or bilateral tubal blockage diagnosed in hysterosalpingography (HSG).  Thus 18 patients in the age group of 20-40 years were registered for the study, with 75% primary infertility and 25% secondary infertility. Of these patients 16 completed the course of treatment. Patients having acute pelvic infection, hypersensitivity to chemical dye, congenital anomalies of vulva & vagina, CA cervix, STD or any debilitating diseases like T.B. were excluded. Apamagra Kshara Taila was selected for its Vata-Kapha Shamaka and Lekhana properties. The dose of Uttar Basti was 5 ml with duration of two consecutive cycles at the interval of three days. The tubal blockage was removed in 75% of the patients and 25% of the patients had conceived within the follow-up period of two months. The results suggest that Uttar Basti is a safer, cost effective and highly significant Ayurvedic treatment modality for tubal-blockage, with no apparent complications.

Long-term follow-up of a multicenter phase II study of chemo-immunotherapy in the treatment of metastatic colorectal cancer (MCC).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 536-536 ◽  
Author(s):  
F. Recchia ◽  
G. Candeloro ◽  
S. Necozione ◽  
P. Lippe ◽  
G. Desideri ◽  
...  
Keyword(s):  
Low Dose ◽  
Low Cost ◽  
Interleukin 2 ◽  
Progression Free Survival ◽  
Cost Effective ◽  
Long Term Follow Up ◽  
Secondary Endpoints ◽  
Grade 3 ◽  
The Cost

536 Background: The combination of low-dose interleukin-2 (IL-2) and 13-cis retinoic acid (RA) has been shown to decrease vascular endothelial growth factor (VEGF) of patients with MCC (Anticancer Res, 2005). Moreover, results of various studies have shown that the addition of IL-2 and RA to chemotherapy (CT) increased treatment efficacy, inducing a statistically significant decrease of VEGF, with a low cost. Methods: Patients with MCC, deemed unresectable, were given the following treatment for two consecutive days (D1-D2): Oxaliplatin 50 mg/m2, Leucovorin (LV), 200 mg/m2, 5-fluorouracil (5-FU) 400 mg/m2, Capecitabine (C) 2,000 mg/m2 (FOCFOX). After 2 weeks Camptothecin, 90 mg/m2 (D1-D2), was administered with the same doses of LV, 5-FU and C (FOCFIRI) as first-line treatment of MCC. Subcutaneous IL-2 1.8 x 106 I.U. and oral RA, 0.5 mg/kg were given 5 days/week. Induction CT was administered for 12 courses, alternating FOCFOX and FOCFIRI, followed by maintenance treatment with the same schedule of IL-2 + RA, for 3 weeks/month. The primary endpoint was the decrease ≥ 30% of VEGF of patients with MCC. Secondary endpoints were the cost of IL-2 and RA with respect to bevacizumab, toxicity, progression- free survival (PFS), and overall survival (OS). Results: From 08/2000 to 08/2006, fifty-four patients with MCC were entered into the trial. After a median follow up of 64 months (95% CI 62-85%), a statistically significant > 30% (p<0.001) decrease of VEGF was observed. Costs of therapy were $ 304.00/month for IL-2/RA and $ 1,700.00/month for bevacizumab (82% cost reduction). The most common adverse events of CT were grade 3/4 neutropenia, leukopenia, thrombocythopenia, and anemia in 33%, 9%, 2%, and 2% of patients, respectively, peripheral neuropathy in 10% of patients. Mild cutaneous skin rash, fever and autoimmune reactions were observed in the patients who received the maintenance immunotherapy. PFS at 10 months was 76% (95% CI 62-86). Median PFS was 27.8 months, while median OS was 48.8 months. Conclusions: These data show that maintenance immunotherapy with low-dose IL-2 and oral RA in patients with MCC has a low toxicity profile, is cost effective, decrease VEGF and seems to improve expected PFS and OS. No significant financial relationships to disclose.

Bedside Modified Clagett Procedure for Empyema after Pulmonary Resection

2006 ◽  
Vol 72 (7) ◽  
pp. 627-630
Author(s):  
W. Brent Keeling ◽  
Joseph R. Garrett ◽  
Nasreen Vohra ◽  
Thomas S. Maxey ◽  
Elizabeth Blazick ◽  
...  
Keyword(s):  
Pulmonary Resection ◽  
Cost Effective ◽  
Operative Management ◽  
Outcome Data ◽  
Operative Procedures ◽  
Single Institution ◽  
Thoracostomy Tube ◽  
Initial Procedure ◽  
Mean Time

The objective of this study is to demonstrate the effectiveness and feasibility in treating empyema after pulmonary resection with a modified Clagett procedure performed at the bedside (BMCP). A retrospective review of a single surgeon's experience at a single institution was undertaken. All operative, postoperative, and outcome data were analyzed. Follow-up data were obtained from subsequent clinic charts. Five patients, including four males, were identified who underwent BMCP after pulmonary resection. The original operative procedures included two lobectomies, one pneumonectomy, one bilobectomy, and one bilateral metastastectomy. Patients were diagnosed with an empyema (positive thoracostomy tube culture, fever, and radiographic abnormality) at a mean time of 31 days from their initial procedure. Culture results disclosed Gram-positive empyemas in all patients. Three patients underwent BMCP as an outpatient, whereas the other two had BMCP during their hospitalizations. All patients are free from complications or recurrence at a mean follow up of 11.2 months. No patient required a further procedure after BMCP. The bedside modified Clagett procedure is both safe and effective. It is a valuable option in the management of postoperative empyema because it avoids additional operative procedures. This procedure is cost-effective when compared with operative management of perioperative empyema.

scholarly journals Outcome of management of congenital idiopathic clubfoot by ponseti technique

2016 ◽  
Vol 48 (1-2) ◽  
pp. 11-15
Author(s):  
Md Mehedi Newaz ◽  
Avijit Kumar Sikder
Keyword(s):  
Treatment Protocol ◽  
Cost Effective ◽  
Idiopathic Clubfoot ◽  
Age Group ◽  
Downward Spiral ◽  
Study Population ◽  
Percutaneous Tenotomy ◽  
Hind Foot ◽  
Medial Release

The congenital idiopathic clubfoot (CICF) is one of the most common serious birth defect of human bones and joints. Deformity leads to downward spiral of disability, dependency and demoralization. The Ponseti technique has become the standard for treatment of congenital clubfoot in the last 2 decades and a triumph in the very complex field of management of congenital idiopathic clubfoot. In this clinical study, our main aim is to evaluate necessity of the Ponseti treatment protocol in a timely, safe, effective & sustainable manner. In this clinical trial, 621 patients (with a total 1033 feet) of 00 (from birth) to 36 months of age were selected as the study population since October, 2009. Most of them were male children (71.3%) and majority were in >03-06 months of age group. In most of the patients (about 92%), only 05 serial plasters were found to be effective & quite sufficient, whereas, only in 5.3% patients, 06-07 plasters were required followed by 1.7% patients requiring more than 07 plasters. In this study, 06 resistant cases were found where correction was relatively slower than others, but no case of treatment failure was identified. The Mid foot score (MS) found to fall greatly in plaster phases and at the end of 5h plaster it was significantly lower (0.2), whereas, in case of the Hind foot score (HS), it declined rapidly following the percutaneous tenotomy (0.2) Then the total score (TS) trends to fall to near 0, at the end of 3rd post SFAB (Steenbeek Foot Abduction Brace) routine follow up and is maintained thereafter. Approximately 74. 1% patients ultimately required tenotomy of Tendo Achilles as a part of management and the rate was highest (83.6%) in >30-36 months age group, followed by 80.0% in >24-30 months age group. The relapse rate was estimated within post SFAB routine follow up, 1.9% was within 1st 6 months & 2-1% within 6 12 months after removal of bracing. All steps in all patients were done as day case procedures. No cases of posterior-medial release was required, as like the conventional or the original Ponseti treatment protocol, hence found cost effective to the patients with excellent patient's compliance (P<0.01)Bang Med J (Khulna) 2015; 48 : 11-15

scholarly journals Pharmacokinetic study of rational regimen of oral clindamycin in comparison with doxycycline in mild cases of acne vulgaris

2017 ◽  
Vol 6 (11) ◽  
pp. 2616
Author(s):  
N. Arivazhagan ◽  
R. Saravana Kumar ◽  
R. Arbind Kumar
Keyword(s):  
Low Dose ◽  
Acne Vulgaris ◽  
Tertiary Care ◽  
Chronic Inflammatory Disease ◽  
Causative Organism ◽  
Age Group ◽  
Propionibacterium Acne ◽  
Common Skin ◽  
Dose Oral

Background: Acne vulgaris is a chronic inflammatory disease of pilosebaceous units. It is a common skin disorder affecting both boys and girls in the adolescent age group and also extends into the post adolescent age group. From time immemorial, various remedies have been suggested and followed by Ayurvedic, Siddha, Unani practitioners and native healers present in various parts of the world. In this study an attempt has been made to evaluate the efficacy of a low dose oral Clindamycin in Acne vulgaris and the results of the study have been presented in ensuing chapters.Methods: The Prospective, Randomized Controlled, Single blind study was conducted in Out Patient Section, Department of Dermatology, tertiary care teaching hospital September 2016 to May 2017 for Total six weeks. Drug administration - four weeks. Follow up - two weeks mostly drug used Capsule Clindamycin 50mg. Capsule Doxycycline 100 mg. Benzoyl Peroxide 5% topical cream.Results: The objective of the study is not only to find out the efficacy of a low dose of 50 mg Clindamycin given orally, but also to find out if this efficacy is obtained without producing the adverse effects for which the administration of Clindamycin is hesitated the ant-microbial, Cap. Doxycycline and Cap. Clindamycin act in acne vulgaris by their effect on the Propionibacterium acne. These antibiotics decrease the population of Propionibacterium acne which in turn leads to the inhibition of the bacterial lipases and this is followed by a decrease in concentration of free fatty acids. This produces less tissue inflammation and acne.Conclusions: This study proves the safety and efficacy of low dose of oral Clindamycin in acne vulgaris, and such low doses can also be tried for other infections where the causative organism responds to Clindamycin. 

1172: Improved Recovery of Erectile Function with Nightly Low dose Sildenafil - 18 Months Follow-Up After Nerve-Sparing Radical Prostatectomy

2007 ◽  
Vol 177 (4S) ◽  
pp. 386-387
Author(s):  
Andreas Bannowsky ◽  
Heiko Schulze ◽  
Christof van der Horst ◽  
Stefan Hautmann ◽  
Klaus P. Juenemann
Keyword(s):  
Radical Prostatectomy ◽  
Erectile Function ◽  
Low Dose ◽  
Nerve Sparing

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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