A cost-utility analysis of different antiviral medicine regimens in patients with chronic hepatitis C virus genotype 1 infection

Background: Despite the introduction of new drug regimens with high effectiveness for the hepatitis C virus (HCV) patients, especially in HCV genotype 1, no cost-effectiveness study on the selection of the superior drug strategy in Iran has been conducted yet. Objectives: This study is aimed to assess the cost-effectiveness of the three drug regimens of pegylated interferon and ribavirin (PR), sofosbuvir (SOF) + PR and ledipasvir and sofosbuvir (LDV/SOF) in patients with HCV genotype 1 in Iran in the year 2014. Methods: A Markov micro-simulation model was used to evaluate the cost-effectiveness of the three drug strategies for a cohort of 10000 patients. Quality-adjusted life-years (QALYs) were extracted from published studies. Cost data was estimated through the review of medical records and obtaining experts opinion. Results: The results showed that the SOF + PR drug compared with PR had a lower cost and was more effective, but compared with the LDV/SOF, in spite of its lower cost, it was less efficient. The QALY values obtained for PR, SOF + PR and LDV/SOF, respectively, were 10.98, 12.08 and 12.28 and their costs were $41,741,$ 7,676 and $46,993. Moreover, the results obtained from acceptability curves showed that SOF + PR were the most cost-effective treatment for thresholds below$ 45,270 PPP. Conclusions: The use of SOF + PR regimen or LDV/SOF can significantly reduce the incidence of complications associated with the disease. For example, short and long-term outcomes are better than the current drug regimens for HCV genotype 1 patients in all stages of the disease

A cost utility and cost effectiveness analysis of different oral antiviral medications in patients with HBeAg-Negative chronic hepatitis B in Iran: an economic microsimulation decision model

Background: Although hepatitis B infection is the major cause of chronic liver disease in Iran, no studies have employed economic evaluations of the medications used to treat Iranian patients with chronic hepatitis B (CHB). Therefore, the cost-effectiveness of the different treatment options for this disease in Iran is unknown. Objectives: The aim of this study was to compare the cost utility and cost-effectiveness of medication strategies tailored to local conditions in patients with HB e antigen (HBeAg)-negative CHB infection in Iran. Methods: An economic evaluation of the cost utility of the following five oral medication strategies was conducted: adefovir (ADV), lamivudine (LAM), ADV + LAM, entecavir (ETV), and tenofovir (TDF). A Markov microsimulation model was used to estimate the clinical and economic outcomes over the course of the patient’s lifetime and based on a societal perspective. Medical and nonmedical direct costs and indirect costs were included in the study and life-years gained (LYG) and quality-adjusted life-years (QALY) were determined as measures of effectiveness. The results are presented in terms of the incremental cost-effectiveness ratio (ICER) per QALY or LYG. The model consisted of nine stages of the disease. The transition probabilities for the movement between the different stages were based on clinical evidence and international expert opinion. A probabilistic sensitivity analysis (PSA) was used to measure the effects of uncertainty in the model parameters. Results: The results revealed that the TDF treatment strategy was more effective and less costly than the other options. In addition, TDF had the highest QALY and LYG in the HBeAg-negative CHB patients, with 13.58 and 21.26 (discounted) in all comparisons. The PSA proved the robustness of the model results. The cost-effectiveness acceptability curves showed that TDF was the most cost-effective treatment in 59% - 78% of the simulations of HBeAg-negative patients, with WTP thresholds less than $14010 (maximum WTP per QALY). Conclusions: The use of TDF in patients with HBeAg-negative CHB seemed to be a highly cost-effective strategy. Compared with the other available medication options, TDF was the most cost-saving strategy. Thus, TDF may be the best option as a first-line medication. Patients can also be switched from other medications to TDF

Review on feverfew, a valuable medicinal plant

Background and Aims: Feverfew (Tanacetum parthenium) is a valuable medicinal plant from Asteraceae family with various pharmacological and therapeutic properties. In this article we reviewed the various aspects of feverfew including botanical characteristics, cultivation and production and medicinal and clinical uses.Material and Methods: Google Scholar, PubMed, EBSCO, Directory of open access journals (DOAJ), EMBASE, and Web of Science were searched using the keywords feverfew and parthenolide. Results: The essential oil of feverfew is frequently used in pharmaceutical and cosmetic industries. Parthenolide is the most important active component of feverfew that is used for the treatment of a wide variety of diseases such as fever, migraine headache, and rheumatoid arthritis.Conclusion:  Feverfew has several positive clinical uses and has the potential to be considered as a new drug for the treatment of some diseases

Nikfar Domination in Neutrosophic Graphs

Many various using of this new-born fuzzy model for solving real-world problems and urgent requirements involve introducing new concept for analyzing the situations which leads to solve them by proper, quick and efficient method based on statistical data. This gap between the model and its solution cause that we introduce nikfar domination in neutrosophic graphs as creative and effective tool for studying a few selective vertices of this model instead of all ones by using special edges. Being special selection of these edges affect to achieve quick and proper solution to these problems. Domination hasn't ever been introduced. So we don't have any comparison with another denitions. The most used graphs which have properties of being complete, empty, bipartite, tree and like stuff and they also achieve the names for themselves, are studied as fuzzy models for getting nikfar dominating set or at least becoming so close to it. We also get the relations between this special edge which plays main role in doing dominating with other special types of edges of graph like bridges. Finally, the relation between this number with other special numbers and characteristic of graph like order are discussed

Privacy and the New Age of Technology

This past June, the Supreme Court decided the case Carpenter v. United States, which some may call one of the most influential and important opinions of our time. This case calls into question the government’s access to information provided by a device that is most probably within one foot of you right now. That’s right – your cell phone. The issue presented in this case is whether the Government conducts a search under the Fourth Amendment when it accesses historical cell phone records that provide a comprehensive chronicle of the user’s past movements. This post was originally published on the Cardozo Arts & Entertainment Law Journal website on October 3, 2018. The original post can be accessed via the Archived Link button above

Serum levels of interleukin-6 and interleukin-8 as diagnostic markers of acute pyelonephritis in children

PurposeEarly diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL)-6 and IL-8 in children with acute pyelonephritis.MethodsEighty-seven patients between 1 month to 12 years old with urinary tract infection (UTI) were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid renal scan: acute pyelonephritis (n=37) and lower UTI (n=50) groups. White blood cell (WBC) count, neutrophil (Neutl) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared.ResultsThere was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05). In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively). The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP.ConclusionThis study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI

Compression-after-impact (CAI) performance of epoxycarbon fibre-reinforced nanocomposites using nanosilica and rubber particle enhancement.

One of the problems in the design of automotive structures and body parts made by fibre reinforced composites is that these materials are susceptible to a small energy impact caused by for instance, accidental tool drop during maintenance or stone strike while in operation. This often lead to a barely visible impact damage which causes reduction in compressive strength of the composite part. To increase the impact tolerance of the composites, toughening agents like silica nanoparticles and rubber particles can be utilized to toughen the resin. To understand the effect of the particles enhancement, the impact tolerance was evaluated utilizing Compression After Impact (CAI) test after the impact induced by gas-gun impacting equipment. The results from CAI test after 20 J impact (high energy stone strike) shows about 30% improvement in residual compressive strength for the nanosilica enhanced composite compared to unmodified CFRP. Also C-scan results after 7 J impact shows about 50% smaller delamination area for the nano-enhanced composite