On the probability of cost-effectiveness using data from randomized clinical trials

BACKGROUND: Acceptability curves have been proposed for quantifying the probability that a treatment under investigation in a clinical trial is cost-effective. Various definitions and estimation methods have been proposed. Loosely speaking, all the definitions, Bayesian or otherwise, relate to the probability that the treatment under consideration is cost-effective as a function of the value placed on a unit of effectiveness. These definitions are, in fact, expressions of the certainty with which the current evidence would lead us to believe that the treatment under consideration is cost-effective, and are dependent on the amount of evidence (i.e. sample size). METHODS: An alternative for quantifying the probability that the treatment under consideration is cost-effective, which is independent of sample size, is proposed. RESULTS: Non-parametric methods are given for point and interval estimation. In addition, these methods provide a non-parametric estimator and confidence interval for the incremental cost-effectiveness ratio. An example is provided. CONCLUSIONS: The proposed parameter for quantifying the probability that a new therapy is cost-effective is superior to the acceptability curve because it is not sample size dependent and because it can be interpreted as the proportion of patients who would benefit if given the new therapy. Non-parametric methods are used to estimate the parameter and its variance, providing the appropriate confidence intervals and test of hypothesis

Effect of Berberine on in vitro metabolism of Sulfonylureas: a herb-drug interactions study

Rationale: Patients with type 2 diabetes may co-ingest herbal and prescription medicine to control their blood sugar levels. Competitive binding of drug and herb may mutually affect their metabolism. This can alter the level of drug and its kinetics in the body, potentially causing toxicities or loss of efficacy. Understanding how metabolism of sulfonylureas like glyburide and gliclazide can be affected by the presence of berberine and vice versa can provide valuable information on the possible risk of toxicities caused by co-ingestion of drugs. Methods: Berberine and sulfonylureas (glyburide and gliclazide) were co-incubated with rat liver microsomes in the presence of NADPH regenerating system. The metabolites of berberine and sulfonylureas were analysed using liquid chromatography with high resolution mass spectrometry in the positive ion mode. The role of individual isozymes in the metabolism of berberine, glyburide and gliclazide was investigated by using specific inhibitors. Results: In vitro metabolism of berberine lead to the formation of demethyleneberberine (B1a) and B1b through demethylenation. Berberrubine (B2a) and its isomer (B2b) was formed through demethylation. The isozymes CYP3A and CYP2D were found to be involved in the metabolism of berberine. In vitro metabolism of glyburide and gliclazide lead to the formation of hydroxylated metabolites. The isozymes CYP3A and CYP2C were found to be involved in the metabolism of glyburide. Gliclazide was metabolised by CYP2C. In vitro co-incubation of glyburide or gliclazide with berberine showed that each drugs metabolism was compromised as both share a common isozymes. A strong negative linear correlation of glyburide or gliclazide metabolites levels and the concentration of berberine confirmed the effect of berberine on the metabolism of sulfonylurea

Primary tubercular liver abscess in an immunocompetent adult: a case report

<p>Abstract</p> <p>Introduction</p> <p>Isolated primary tubercular abscess is one of the rare forms of extrapulmonary tuberculosis. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality.</p> <p>Case presentation</p> <p>A 30-year-old man, of Asian origin, developed a hepatic tubercular abscess which was not associated with any pulmonary or gastrointestinal tract foci of tuberculosis. An ultrasonogram of the abdomen showed an abscess in the right lobe of his liver which was initially diagnosed as an amoebic liver abscess. Subsequently, the pus from the lesion yielded <it>Mycobacterium tuberculosis </it>using the BACTEC TB 460 instrument and <it>Mycobacterium tuberculosis </it>deoxyribonucleic acid by polymerase chain reaction. The patient was started on systemic antitubercular therapy to which he responded favorably.</p> <p>Conclusion</p> <p>This report emphasizes the fact that, although a tuberculous liver abscess is a very rare entity, it should be included in the differential diagnosis of unknown hepatic mass lesions.</p

Comparative study between the Hybrid Capture II test and PCR based assay for the detection of human papillomavirus DNA in oral submucous fibrosis and oral squamous cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Oral malignancy is a major global health problem. Besides the main risk factors of tobacco, smoking and alcohol, infection by human papillomavirus (HPV) and genetic alterations are likely to play an important role in these lesions. The purpose of this study was to compare the efficacy of HC-II assay and PCR for the detection of specific HPV type (HPV 16 E6) in OSMF and OSCC cases as well as find out the prevalence of the high risk HPV (HR-HPV) in these lesions.</p> <p>Methods and materials</p> <p>Four hundred and thirty patients of the potentially malignant and malignant oral lesions were taken from the Department of Otorhinolaryngology, Moti Lal Nehru Medical College, Allahabad, India from Sept 2007-March 2010. Of which 208 cases were oral submucous fibrosis (OSMF) and 222 cases were oral squamous cell carcinoma (OSCC). The HC-II assay and PCR were used for the detection of HR-HPV DNA.</p> <p>Result</p> <p>The overall prevalence of HR-HPV 16 E6 DNA positivity was nearly 26% by PCR and 27.4% by the HC-II assay in case of potentially malignant disorder of the oral lesions such as OSMF. However, in case of malignant oral lesions such as OSCC, 32.4% HPV 16 E6 positive by PCR and 31.4% by the HC-II assay. In case of OSMF, the two test gave concordant result for 42 positive samples and 154 negative samples, with an overall level of agreement of 85.4% (Cohen's kappa = 66.83%, 95% CI 0.553-0.783). The sensitivity and specificity of the test were 73.7% and 92.05% (p < 0.00). In case of OSCC, the two test gave concordant result for 61 positive samples and 152 negative samples, with an overall level of agreement of 88.3% (Cohen's kappa = 79.29, 95% CI 0.769-0.939) and the sensitivity and specificity of the test were 87.14% and 92.76% (p < 0.00).</p> <p>Conclusion</p> <p>This study concluded that slight difference was found between the positivity rate of HR-HPV infection detected by the HC-II and PCR assay in OSMF and OSCC cases and the HC II assay seemed to have better sensitivity in case of OSCC.</p

Evaluation of chemiluminescence, toluidine blue and histopathology for detection of high risk oral precancerous lesions: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Early detection holds the key to an effective control of cancers in general and of oral cancers in particular. However, screening procedures for oral cancer are not straightforward due to procedural requirements as well as feasibility issues, especially in resource-limited countries.</p> <p>Methods</p> <p>We conducted a cross-sectional study to compare the performance of chemiluminescence, toluidine blue and histopathology for detection of high-risk precancerous oral lesions. We evaluated 99 lesions from 55 patients who underwent chemiluminescence and toluidine blue tests along with biopsy and histopathological examination. We studied inter-as well as intra-rater agreement in the histopathological evaluation and then using latent class modeling, we estimated the operating characteristics of these tests in the absence of a reference standard test.</p> <p>Results</p> <p>There was a weak inter-rater agreement (kappa < 0.15) as well as a weak intra-rater reproducibility (Pearson's r = 0.28, intra-class correlation rho = 0.03) in the histopathological evaluation of potentially high-risk precancerous lesions. When compared to histopathology, chemiluminescence and toluidine blue retention had a sensitivity of 1.00 and 0.59, respectively and a specificity of 0.01 and 0.79, respectively. However, latent class analysis indicated a low sensitivity (0.37) and high specificity (0.90) of histopathological evaluation. Toluidine blue had a near perfect high sensitivity and specificity for detection of high-risk lesions.</p> <p>Conclusion</p> <p>In our study, there was variability in the histopathological evaluation of oral precancerous lesions. Our results indicate that toluidine blue retention test may be better suited than chemiluminescence to detect high-risk oral precancerous lesions in a high-prevalence and low-resource setting like India.</p

Antibacterial activity of some selected medicinal plants of Pakistan

<p>Abstract</p> <p>Background</p> <p>Screening of the ethnobotenical plants is a pre-requisite to evaluate their therapeutic potential and it can lead to the isolation of new bioactive compounds.</p> <p>Methods</p> <p>The crude extracts and fractions of six medicinal important plants (<it>Arisaema flavum</it>, <it>Debregeasia salicifolia</it>, <it>Carissa opaca</it>, <it>Pistacia integerrima</it>, <it>Aesculus indica</it>, and <it>Toona ciliata</it>) were tested against three Gram positive and two Gram negative ATCC bacterial species using the agar well diffusion method.</p> <p>Results</p> <p>The crude extract of <it>P. integerrima </it>and <it>A. indica </it>were active against all tested bacterial strains (12-23 mm zone of inhibition). Other four plant's crude extracts (<it>Arisaema flavum</it>, <it>Debregeasia salicifolia</it>, <it>Carissa opaca</it>, and <it>Toona ciliata</it>) were active against different bacterial strains. The crude extracts showed varying level of bactericidal activity. The aqueous fractions of <it>A. indica </it>and <it>P. integerrima </it>crude extract showed maximum activity (19.66 and 16 mm, respectively) against <it>B. subtilis</it>, while the chloroform fractions of <it>T. ciliata </it>and <it>D. salicifolia </it>presented good antibacterial activities (13-17 mm zone of inhibition) against all the bacterial cultures tested.</p> <p>Conclusion</p> <p>The methanol fraction of <it>Pistacia integerrima</it>, chloroform fractions of <it>Debregeasia salicifolia </it>&<it>Toona ciliata </it>and aqueous fraction of <it>Aesculus indica </it>are suitable candidates for the development of novel antibacterial compounds.</p

Towards the automated localisation of targets in rapid image-sifting by collaborative brain-computer interfaces

The N2pc is a lateralised Event-Related Potential (ERP) that signals a shift of attention towards the location of a potential object of interest. We propose a single-trial target-localisation collaborative Brain-Computer Interface (cBCI) that exploits this ERP to automatically approximate the horizontal position of targets in aerial images. Images were presented by means of the rapid serial visual presentation technique at rates of 5, 6 and 10 Hz. We created three different cBCIs and tested a participant selection method in which groups are formed according to the similarity of participants’ performance. The N2pc that is elicited in our experiments contains information about the position of the target along the horizontal axis. Moreover, combining information from multiple participants provides absolute median improvements in the area under the receiver operating characteristic curve of up to 21% (for groups of size 3) with respect to single-user BCIs. These improvements are bigger when groups are formed by participants with similar individual performance, and much of this effect can be explained using simple theoretical models. Our results suggest that BCIs for automated triaging can be improved by integrating two classification systems: one devoted to target detection and another to detect the attentional shifts associated with lateral targets