Cost-analysis of treatment of childhood acute lymphoblastic leukemia with asparaginase preparations: The impact of expensive chemotherapy

__Abstract__ Asparaginase is an expensive drug, but important in childhood acute lymphoblastic leukemia. In order to compare costs of PEGasparaginase, Erwinia asparaginase and native E. coli asparaginase, we performed a cost-analysis in the Dutch Childhood Oncology Group ALL-10 medium-risk group intensification protocol. Treatment costs were calculated based on patient level data of 84 subjects, and were related to the occurrence of allergy to PEGasparaginase. Simultaneously, decision tree and sensitivity analyses were conducted. The total costs of the intensification course of 30 weeks were $57,893 in patients without PEGasparaginase allergy (n=64). The costs were significantly higher ($113,558) in case of allergy (n=20) necessitating a switch to Erwinia asparaginase. Simulated scenarios (decision tree analysis) using native E. coli asparaginase in intensification showed that the costs of PEGasparaginase were equal to those of native E. coli asparaginase. Also after sensitivity analyses, the costs for PEGasparaginase were equal to those of na

Zooterapia amazônica: uso de gordura de sucuri ( Eunectes murinus ) como cicatrizante natural

Zootherapy (the use of the therapeutic potential of animals) is at least 6,000 years old, and has been kept active throughout generations until modern days. Animal fat is commonly used in the zootherapeutic folk medicine from South America, specially the green anaconda's fat, which is widely promoted as a natural medicine to treat wounds, even though there is no scientific evidence showing its efficacy. In this study we compared the total healing time and the proportional daily reduction of dorsal epithelial incisions in adult male Wistar rats treated with nitrofural (a commercial cicatrizing ointment) and with anaconda fat. We applied the treatments every two days and measured the incision diameter daily, during ten consecutive days. Differences among the groups in the total healing time and in the proportional daily reduction of the incision consistently showed that the fat-based treatment resulted in a faster healing process compared to the commercial ointment tested. The literature suggests that the efficacy of animal fat on healing may be primarily related to the presence of fatty acids, which have been widely demonstrated to be important for biochemical reactions involved in healing processes. Our findings are widely socially relevant, considering that traditional Amazonian communities that use anaconda fat in folk medicine do not have easy access to pharmacies and hospitals.Práticas ancestrais de zooterapia (uso das potencialidades terapêuticas da fauna) existem há pelo menos 6000 anos, e têm sido mantidas ao longo de gerações até os tempos modernos. Gordura de animais é comumente utilizada na zooterapia tradicional da América do Sul, e a gordura de serpentes sucuris é amplamente comercializada como cicatrizante natural, embora não existam evidências científicas que mostrem sua eficácia terapêutica. Neste estudo comparamos o tempo de cicatrização epitelial total e a redução proporcional diária de uma incisão dorsal em ratos Wistar machos adultos, entre um grupo controle, um grupo tratado com nitrofural (uma pomada cicatrizante comercial) e um grupo tratado com gordura de sucuri. Nós aplicamos os tratamentos a cada dois dias e medimos o diâmetro da incisão diariamente por dez dias consecutivos. Diferenças entre os grupos no tempo de cicatrização total e na redução proporcional diária da incisão consistentemente mostraram que gordura de sucuri teve ação cicatrizante mais eficiente que a pomada comercial testada. A literatura sugere que a eficácia de gordura animal em processos de cicatrização pode estar principalmente relacionada à presença de ácidos graxos, os quais têm sido amplamente demonstrados como importantes para reações bioquímicas envolvidas em processos de cicatrização. Os resultados têm ampla relevância social, considerando que as comunidades tradicionais amazônicas que utilizam a gordura de sucuris como zooterápico não têm acesso fácil a farmácias e hospitais

Cardiovascular Disease Risk Factors, Depression Symptoms and Antidepressant Medicine Use in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Diabetes

Aims/hypothesis - To determine the associations of baseline depression symptoms and use of antidepressant medicines (ADMs) with baseline cardiovascular disease (CVD) risk factors in Look AHEAD (Action for Health in Diabetes) trial participants. Methods - Look AHEAD participants (n = 5,145; age 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m2) were assessed for CVD risk factors (elevated HbA1c or insulin use, elevated BP or antihypertensive use, elevated lipid levels or lipid-lowering medication, current smoking, BMI ≥30 kg/m2, lower peak exercise capacity assessed as metabolic equivalents [METs], and ankle–brachial index \u3c0.9 or \u3e1.3). Participants also completed the Beck Depression Inventory (BDI) and reported their use of ADMs. Results - Of the participants, 14.7% had BDI scores ≥11, consistent with mild-moderate depression, and 16.5% took ADMs; 4.4% had both depression markers (i.e. elevated symptom scores and took ADMs). In logistic regression analyses of CVD risk (elevated risk factor or use of medication to control the risk factor), controlled for demographic factors, continuous BDI scores and ADM use were each independently associated with elevated BP (or medication), current smoking, BMI ≥30 kg/m2 and lower MET values. ADM use was also associated with elevated serum lipids or use of lipid-lowering medication. Conclusions/interpretation - Among Look AHEAD participants, depression symptoms or ADM use on entry to the study were each independently associated with a wide range of CVD risk factors. Future research should assess the temporal dynamics of the relationships of depression symptoms and ADM use with CVD risk factors

Successful Weight Loss Maintenance and a Shift in Identity From Restriction to a New Liberated Self

The present qualitative study aims to explore the experiences of dieters who successfully maintain their weight loss with a focus on the transition in perception of self from their heaviest to their current reduced weight. Ten successful women from a slimming club who had lost at least 10 per cent of their weight for a minimum of one year participated in the study. The results showed an identity shift from a previous restrained self towards a liberated individual, regarding their social interactions, dietary habits, emotional regulation and self-appraisal. The results are discussed in terms of the process of reinvention and the impact of stigma on an obese person’s self-identity