Cost effectiveness of epidural steroid injections to manage chronic lower back pain

Background The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. Methods Patients attending the Nottingham University Hospitals’ Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. Results 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 – 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 – 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 – 70,091). Conclusions When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness

Rituximab in Adult –Onset Still’s Disease: Case Report

Summary: Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is characterized by high grade fever, skin rash, arthritis, leukocytosis, increased ESR, CRP and liver enzyme levels and high levels of ferritin. The treatment of AOSD includes NSAIDs, steroids, and disease-modifying antirheumatic drugs (DMARDs). Recently biologic agents have been used for treatment of some rheumatologic disorders. Rituximab(MabThera), an anti-CD20 monoclonal antibody is one of the biologic agents which is used by only a few researchers for treatment of refractory AOSD. Herein, we describe a 23 year old woman, who was treated with Rituximab ,three years after diagnosis of AOSD .She did not respond to Metotroxate and Cellcept .After administration of Rituximab, clinical and laboratory remission was achieved

Cyclosporine-induced reflex sympatethic dystrophy syndrome in a patient with graft versus host disease after bone marrow transplantation: a case report

"nBackground: Reflex Sympathetic Dystrophy Syndrome (RSDS) is a rarely described complication which characterized by pain, edema, movement and vasomotor disorders, trophic changes in the skin and patchy demineralization of bone in extremities. There are numerous risk factors such as trauma, surgery, myocardial infraction and drugs. Cyclosporine (CsA) is one of the drugs which can induce RSDS. "nCase report: Herein we described a 33- years old man (known case of ALL) with severe painful and edematous extremities, which was being treated with cyclosporine because of Graft Versus Host Disease (GVHD) after bone marrow transplantation. His laboratory tests were normal except for AST and ALT. With impression of Reflex Sympathetic Dystrophy Syndrome triple-phase bone scan was done, Increased uptake and delayed wash-out in vascular and bony phase is considered typical for RSDS. Due to clinical and triple-phase bone scan findings the diagnosis was established. Symptoms of RSDS improved when CsA was discontinued. "nConclusion: According to this case report and the other ones, Cyclosporine should be considered as the etiology of Reflex Sympathetic Dystrophy Syndrome

Effect of Corticosteroids in Routine Treatment of PeriTonsillar Abscess

Introduction: There are controversies regarding treatment of peritonsillar abscess as a common infection of head and neck, especially for prescription of corticosteroids. According to review of articles, use of corticosteroids in management of this abscess is increasing, but more controlled and comparative studies are needed. In this clinical trial study, we evaluated corticosteroid as an adjutant therapy for peritonsillar abscess. Methods: This clinical trial study was done on 50 hospitalized patients divided into 2 groups; steroid and placebo. Antibiotic therapy and method of abscess drainage was the same in both groups. A special questionnaire included characteristics, symptoms, clinical course and complications of patients. Data was filled and analyzed by SPSS software using chi square, repeated measurement and t tests. Results: Normalization of body temperature within 12 hours after treatment and mean time of painless swallowing was 100% and 9 hours in the steroid group as compared to 84% and 15 hours in placebo group (p value=0.04). Trismus recovery was faster in steroid group. Hospitalization period was 3 and 4 days in steroid and placebo groups, respectively (P value>0.05). Fewer complications were reported in steroid receiving patients. There was one case of relapse in the steroid group and 5 cases in the placebo group (P value=0.09). Conclusion: According to our findings, it seems that corticosteroid adjuvant therapy of peritonsillar abscess is effective and doesn’t lead to any important complicatio

Familial Aggrigation of Fmr and Bechet, S Diseases in Their Mother

Familial Mediterranean fever (FMF) is a hereditary condition which is characterized by recurrent episodes of fever and abdominal pain. On the other hand, Behcet`s disease (BD) is an immune mediated condition typified by recurrent oral aphthous lesions, inflammatory eye disease and multiple organ involvement. Association of these two conditions is rare. We present a pair of twins with FMF and BD in their mother

Trend of Knowledge Production of Research Centers in the Field of Medical Sciences in Iran

Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science). Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country

Research Assessment of Iranian Medical Universities, an Experience from a Developing Country

"nInternational ranking of universities by bibliometric assays has received a great attention in recent years. The developing countries have commenced to build their own infrastructure of research and post graduate training during the past couple of years. In 2000, the Ministry of Health and Medical Education of Iran began an annual national survey for assessing research activities in medical universities and their affiliated institutions by applying a customized ranking method. Research indi­cators were scored in three topics; Stewardship, Capacity Building, and Knowledge Production. In 2000, there were about 300 published medical articles in ISI/Thomson and PUBMED from the whole country. This number increased up to 3376 in 2007. The score of indexed papers in international databases per academic member rose from 0.1 in 2000 to 0.63 in 2007. The share of global articles (in the field of Medicine) grew from 0.06% in 2000 to 0.55% in 2007. This rising in article output led to a change from grade 57th in 2000 to 27th in 2007 in the ranking system of Scopus database. The number of local medi­cal journals, which were 53 in 2000, increased to 141 at the end of 2008.  This rising scores was ongoing while the growth of the total staff of the academic members was about 25% (from 9086 in 2000 to 11324 in 2007). The number of the short training courses rose from 458 in 2000 to 1097 in 2007. The registered research projects in health topic rose from less than 3878 in 2000 to 6816 in 2007