Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

BACKGROUND: Fluid and antimicrobial therapy are the essential parts of sepsis management. The type of fluid to resuscitate with is an unsettled issue in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate the cost effectiveness of albumin-based resuscitation over crystalloids.METHODS: A cost-effectiveness analysis was conducted by extracting data from a database of Sina Hospital, Islamic Republic of Iran. A decision tree was constructed by using Tree Age Pro2011. The patients were grouped based on the types of fluids used for resuscitation into crystalloid alone or crystalloid + albumin groups at the initial decision node. The patients were followed from the onset of severe sepsis and septic shock upto 28 days. The healthcare payers’ perspective was considered in constructing the model. The cost was measured in US dollars and the effectiveness was measured by life years gained.RESULTS: The addition of albumin during resuscitation of patients with severe sepsis and septic shock has an effectiveness gain of 0.09 life years and cost increment of 495.00 USD. The estimated ICER for this analysis was 5500.00 USD per life year gained. The probability that albumin is cost-effective at one GDP per capita is 49.5%.CONCLUSION: Albumin-based resuscitation is not cost-effective in Iran when a GDP per capita was considered for a life year gain. The cost-effectiveness was insensitive to the cost of standard care. We recomend the caustious use albumin as per the Surviving Sepsis Campaign guideline.

Evaluation of the Effects of Melatonin Supplementation on Coagulation in Patients with Haemorrhagic Stroke; A Randomized, Double-Blind, Controlled Trial

Introduction: Considering that hemorrhagic stroke patients are at higher risk for bleeding, administration of higher doses of melatonin with a controversial coagulation profile is a serious concern. Objective: This study aimed to investigate the possible effects of high doses of melatonin on bleeding parameters and blood hemostasis in hemorrhagic stroke patients. Methods: This study is a randomized, double-blind, prospective, controlled trial. Confirmed hemorrhagic stroke patients were divided into two groups. Participants were randomly assigned into the melatonin group (30 mg daily via gastric tube gavage for 5 consecutive days) or the control group. Each patient was monitored for 5 days, and 2 blood samples were taken and the effect of the intervention on coagulation factors and blood hemostasis were investigated. Result: In total, 30 patients were randomly assigned to melatonin (n=15) or control groups (n=15). there was no significant difference between the two groups in demographic and clinical characteristics. There was a significant decline in prothrombin time (PT) and fibrinogen levels in the melatonin group (p=0.011 & p<0.001, respectively). P-values for VII and VWB factors showed a significant increment in these two factors in the melatonin group after the intervention (p=0.035 & p=0.002, respectively). No significant changes in serum levels of D-dimer factor, APACHE II, and GCS scores were evident in the two groups after the intervention (p>0.05). Conclusion: Considering the favorable changes in coagulation parameters observed in this study, it could be concluded that melatonin can have both procoagulant and antithrombin properties

Gamma irradiated electron paramagnetic resonance response of carbonate ion implanted hydroxyapatite

In this work, synthetic nano-structure hydroxyapatite samples were doped by carbonate ions with 80 keV of energies during different times of 4, 8, 16, and 24 minutes using an ion implantation device. All the samples were irradiated with the 60Co gamma ray source at different absorbed doses of 5, 10, 20, and 50 kGy and subjected to electron paramagnetic resonance measurements, subsequently. The electron paramagnetic resonance signal intensities were constructed as a function of radiation dose and were compared with the results of non-implanted one, and were studied from dosimetric point of view. The obtained results show a considerable increment in electron paramagnetic resonance signal intensity of the samples which were implanted for 24 minutes

Electrochemical Evaluation of Hydroxyapatite/ZrN Coated Magnesium Biodegradable Alloy in Ringer Solution as a Simulated Body Fluid

Magnesium alloys as biodegradable materials can be used in body as an implant materials but since they have poor corrosion resistance, it is required to decrease their corrosion rate by biocompatible coatings. In this study, hydroxyapatite (HA) coatings in the presence of an intermediate layer of ZrN as a biocompatible material, deposited on AZ91 magnesium alloy by ion beam sputtering method at 300 °C temperature and at different times 180, 240, 300, 360 and 420 min. Then changes in corrosion resistance of samples in Ringer's solution as a solution similar to the human body was evaluated in two ways, potentiodynamic polarization and electrochemical impedance spectroscopy (EIS). To investigate the causes of the destruction of the samples, the surface of samples was studied by scanning electron microscopy (SEM). The results showed that because of porous coatings created, the corrosion potential of the samples was about +55mV higher than the uncoated substrate that by changing the deposition time, was not observed the significant change But with increasing deposition time to 360 min, corrosion current decreased which represents an increase of corrosion resistance of magnesium alloy in body solution. However, a further increase in deposition time to 420 min, due to increase thickness and stress in the layer, the corrosion resistance of the samples was reduced. The results of the EIS confirm the corrosion behavior of the polarization method, too.   </div

Correlation of free fraction of phenytoin and plasma albumin level in head trauma patients

Preliminary data suggests that vital physiologic support measures and free fraction of Phenytoin are altered following head trauma. Therefore , we conducted a prospective , randomized controlled study to determine the correlation of albumin concentration and unbound phenytoin plasmaconcentration following head injury. Ten adult head trauma patients in the neurosurgical intensive care unit receiving phenytoin for the seizure prophylactic treatment were studied for their free and total plasma phenytion concentration in peak and trough times and their respective albumin concentration . Free and total phenytoin levels were determined by both liquid chromatography and flurescence polarization immunoassay (Éclair) of plasma samples after ultrafiltration and deproteinization. No significant difference was found in the plasma concentration measured with HPLC or FPIA while a marked correlation was noted between plasma albumin and free phenytoin concentration (r2=0.85). The total and free phenytoin concentrations were not significantly correlated (r2=0.60) . A remarkable difference (P<0.05) was noticed when doses in patients were adjusted on the basis of total plasma phenytoin and calculated plasma phenytoin adjusted for serum albumin. Therefore , therapeutic monitoring in neurosurgical patients receiving should be performed on the basis of pharmacologically active component (free fraction), rather than total phenytoin which is presently performed in the clinics.5 page(s