Comparison of the cost-effectiveness of transesophgeal and transthoracic echocardiographies to detect cardioembolic causes of stroke in non-selected patients

Background: Both Transthoracic Echocardiography (TTE) and Transesophgeal Echocardiography (TEE) are effective investigation tools to detect cardioaortic sources of embolism in ischemic stroke. Nevertheless, there are still uncertainties about the cost-effectiveness of these methods in non-selected patients with acute stroke. Objectives: This study aimed to investigate the cost-effectiveness of TTE and TEE using a decision analytic model in non-selected patients with acute ischemic stroke with or without clinical and radiological signs of embolic pattern. Patients and Methods: This cross-sectional cost-effectiveness study was performed in Nemazee hospital affiliated to Shiraz University of Medical Sciences from January 2014 to April 2014. TTE and TEE were performed for all 65 consecutive patients with ischemic stroke (51.3 male, mean age of 69.7 ± 17.9 years). The required data were direct costs related to performance of TTE and TEE, which were obtained from the patients� bills in their charts. A decision analytic model was implemented to assess the cost-effectiveness of these two methods, which demonstrated an Incremental Cost-Ef-fectiveness Ratio (ICER). Effectiveness was determined based on the number of disorders diagnosed using each of the two echoes confirmed by two cardiologists. All analyses were done using Tree Age Pro 2011. Results: The results showed that TEE was more expensive than TTE in non-selected patients. Performing TEE increased the cost by 1494 USD and the effectiveness by 7. As per ICER equation, for each increment unit in the effectiveness, performing TEE would increase the cost by 213.4 USD compared to TTE. TEE was cost-effective in comparison to TTE regardless of age factor considering the cutoff of Gross Domestic Product (GDP) by three for ICER. Moreover, TTE was cost-effective in 41-60-and 61-80-year-old age groups, while TEE was cost-effective in the 41-60-year-old age group. However, none of the techniques was cost-effective in patients above 81 years old. Conclusions: The results of this study can help reduce the unnecessary use of echocardiography by considering the age group and their corresponding risk factors for developing ischemic stroke. © 2018, Iranian Cardiovascular Research Journal. All rights reserved

Comparison of the cost-effectiveness of transesophgeal and transthoracic echocardiographies to detect cardioembolic causes of stroke in non-selected patients

Background: Both Transthoracic Echocardiography (TTE) and Transesophgeal Echocardiography (TEE) are effective investigation tools to detect cardioaortic sources of embolism in ischemic stroke. Nevertheless, there are still uncertainties about the cost-effectiveness of these methods in non-selected patients with acute stroke. Objectives: This study aimed to investigate the cost-effectiveness of TTE and TEE using a decision analytic model in non-selected patients with acute ischemic stroke with or without clinical and radiological signs of embolic pattern. Patients and Methods: This cross-sectional cost-effectiveness study was performed in Nemazee hospital affiliated to Shiraz University of Medical Sciences from January 2014 to April 2014. TTE and TEE were performed for all 65 consecutive patients with ischemic stroke (51.3 male, mean age of 69.7 ± 17.9 years). The required data were direct costs related to performance of TTE and TEE, which were obtained from the patients� bills in their charts. A decision analytic model was implemented to assess the cost-effectiveness of these two methods, which demonstrated an Incremental Cost-Ef-fectiveness Ratio (ICER). Effectiveness was determined based on the number of disorders diagnosed using each of the two echoes confirmed by two cardiologists. All analyses were done using Tree Age Pro 2011. Results: The results showed that TEE was more expensive than TTE in non-selected patients. Performing TEE increased the cost by 1494 USD and the effectiveness by 7. As per ICER equation, for each increment unit in the effectiveness, performing TEE would increase the cost by 213.4 USD compared to TTE. TEE was cost-effective in comparison to TTE regardless of age factor considering the cutoff of Gross Domestic Product (GDP) by three for ICER. Moreover, TTE was cost-effective in 41-60-and 61-80-year-old age groups, while TEE was cost-effective in the 41-60-year-old age group. However, none of the techniques was cost-effective in patients above 81 years old. Conclusions: The results of this study can help reduce the unnecessary use of echocardiography by considering the age group and their corresponding risk factors for developing ischemic stroke. © 2018, Iranian Cardiovascular Research Journal. All rights reserved

Protective Effects of IMOD and Cimetidine against Radiation-induced Cellular Damage

Radiation damage is to a large extent caused by overproduction of reactive oxygen species (ROS). Radioprotectors are agents or substances that reduce the effects of radiation in healthy normal tissues while maintaining the sensitivity to radiation damage in tumor cells. Radioprotectors are agents or substances that reduce the effects of radiation in healthy normal tissues while maintaining the sensitivity to radiation damage in tumor cells Cimetidine was found more effective when used in vivo; this effect might be due to the augmentation of the presence of Sulphur atom in the compound which is ‎important for their scavenging activity. Recently, a new herbal-based medicine with immunomodulatory capacities, Setarud (IMOD), was introduced as an additional therapy in various inflammatory diseases and HIV infection. IMOD is a mixture of herbal extracts enriched with selenium. Selenium confers protection by inducing or activating cellular free-radical scavenging systems and by enhancing peroxide breakdown. This article suggests that nontoxic amount of IMOD and cimetidine have radioprotective properties and could reduce cytotoxic effects of radiation

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients’ average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients’ pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved