Dutasteride plus Tamsulosin therapy versus Tamsulosin Monotherapy in the treatment of lower urinary tract symptoms: A Cost-utility analysis

Introduction: Lower Urinary Tract symptoms (LUTS)? impacts the quality of life of about 23.8% of the male population in Iran, diagnosed with Benign Prostatic Hyperplasia, annually . The current pharmacological treatment protocol for LUTS are α-blockers and 5-alpha reductase inhibitors (such as Dutasteride). This study was designed to estimate the cost-utility of dutasteride plus tamsulosin therapy for LUTS from the perspective of the Iran Health System. Methods and Results: A Markov model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients with moderate to severe LUTS. The model, compared four mutually exclusive health states in two alternative treatment options: tamsulosin (0.4 mg/day) and dutasteride plus tamsulosin (0.5mg+0.4 mg/day). time horizon was 35 years, with the duration of one year per cycle. The discount rates for utilities and costs were 3% and 5% respectively. A meta-analysis was conducted to estimate advese drug reactions (ADRs) and After Surgery Events (ASEs) probabilities. Total Cost consists of the direct costs of medications, as well as inpatient and outpatient services (general practice and urology specialist examinations, hospitalizations, laboratory services, diagnostic procedures, TURP surgical procedures, treatment of AUR, and treatment in emergency care services). One-way sensitivity testing and Probabilistic Sensitivity Analyses (PSA) were performed for virtual cohort of 1,000 patients with LUTS. Utility weights for each health states were obtained from a meta-analysis of published studies with EQ5D method. These weights are calculated 0.86, 0.79, 0.72 and 0 in mild, moderate, severe and death states, respectively. The probability of ASEs (CI 95%) were calculated as: TUR syndrome (0-0.0109), Blood transfusion (0.0296-0.0676), Urinary incontinence (0.0198-0.1894), urethral stricture (0.0392-0.0769) and UTI (0.0169-0.0787). After 35 years, the incremental cost-effectiveness ratio for combination therapy was $5159, well within the threshold range typically applied in Iran. PSA showed that the probability of being cost-effective in combination therapy is 89% to 94%, also the model showed the most sensitivity to dutasteride unit price and surgery incidence with monotherapy. Conclusions: Combination therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in Iran

An innovative framework for real-time monitoring of pollutant point sources in river networks

Simultaneous identification of the location and release history of pollutant sources in river networks is an ill-posed and complicated problem, particularly in the case of multiple sources with time-varying release patterns. This study presents an innovative method for solving this problem using minimum observational data. To do so, a procedure is proposed in which, the number and the suspected reaches to the existence of pollutant sources are determined. This is done by defining two different types of monitoring stations with an adaptive arrangement in addition to real-time data collection and reliable flow and transport mathematical models. In the next step, the sources’ location and their release history are identified by solving the inverse source problem employing a geostatistical approach. Different scenarios are discussed for different conditions of number, release history and location of pollutant sources in the river network. Results indicated the capability of the proposed method in identifying the characteristics of the sources in complicated cases. Hence, it can be effectively used for the comprehensive monitoring of river networks for different purposes

DRUJ instability after distal radius fracture: A comparison between cases with and without ulnar styloid fracture

AbstractBackgroundBecause of the importance of the DRUJ in upper extremity function and the prevalence of distal radius fractures, either with or without ulnar styloid fracture, this study was designed to assess the relationship between ulnar styloid fracture and the incidence of DRUJ instability after treatment of distal radius fractures treated with ORIF (volar plate).Methods112 patients suffering from type two and three distal radius fractures (Fernandez classification), were evaluated. Depending on the presence of ulnar styloid avulsion fracture, patients were divided into two groups: 86 cases with isolated radial fracture and 26 cases with a distal radius fracture accompanied by ulnar styloid fracture. All patients underwent distal radius fracture ORIF. CT scanning was done both immediately after surgery and 3 months post-op. DRUJ stability was examined using the modified radioulnar line method and the incidence of DRUJ instability was compared between the two groups.ResultsImmediate instability was seen in 11 patients. Three of these patients had concomitant ulnar styloid fracture and were excluded for further fixation. Three months later, another 9 cases were diagnosed with DRUJ instability, 2 of whom had concomitant ulnar styloid fracture and the other 7 suffered from isolated distal radius fracture. Chi-square test revealed no significant difference (p < 0.05). There were no cases of delayed union or non-union distal radius fracture.ConclusionOur study demonstrated that untreated stable or minimally displaced ulnar styloid fracture accompanied by distal radius fracture, has no adverse effect on DRUJ stability following ORIF of the radius

Optimal SSSC-based power damping inter-area oscillations using firefly and harmony search algorithms

The static synchronous series compensator (SSSC) can add a series reactance to the transmission line, and when it is fed using auxiliary signals, it can participate in damping inter-area oscillations by changing the series reactance. In this paper, the effect of the SSSC on small-signal stability is investigated. The design of a controller for damping oscillations is designed and discussed. Moreover, using the firefly and the harmony search algorithms, the optimal parameters controlling SSSC are addressed. The effectiveness of these two algorithms and the rate of SSSC participation in damping inter-area oscillation are also discussed. MATLAB software was used to analyse the models and to perform simulations in the time domain. The simulation results on the sample system, in two areas, indicated the optimal accuracy and precision of the proposed controller