Is a low sacral ratio associated with primary vesicoureteral reflux in children?

Introduction: The association of sacral anomalies with fecal incontinence and lower urinary tract dysfunction is known. The sacral ratio is proposed as a tool for evaluation of sacral development. The aim of this cross-sectional study was to evaluate the prevalence and severity of vesicoureteral reflux in children with a low sacral ratio. Materials and Methods: Six hundred and sixty nine children who were referred to a radiology clinic for a standard (fluoroscopic) VCUG to detect vesicoureteral reflux and other anomalies of the lower urinary tract after an episode of urinary tract infection were included in the study and their sacral ratios were measured. Results: All children were younger than 14 years of age (mean 3.44±3.20). Of 669 children, 593 (88.6%) had normal sacral ratios out of whom 423 (71.3%) did not have VUR and 170 (28.7%) had VUR. Seventy-six (11.3%) children out of 669 cases had low sacral ratios; 49 (64.5%) of them had no VUR and 27 (35.5%) had VUR. There was no significant difference in the prevalence of VUR between children with and without a low sacral ratio (p value=0.217). Also, there was no significant difference or trend between a low sacral ratio and the severity of reflux (Chi2 for trend). Conclusions: Although sacral anomalies may be related to some cases of VUR by producing lower urinary tract dysfunction, the sacral ratio is not associated with VUR

Cost-effectiveness of different cervical screening strategies in Islamic Republic of Iran: A middle-income country with a low incidence rate of cervical cancer

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26 to 64. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was 8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer. � 2016 Nahvijou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Comparison of the length of shoulder girdle’s muscles, neck and shoulder range of motion in patients with chronic neck - shoulder pain and healthy subjects

Background and Objective: One of the most common musculoskeletal injuries in modern societies is neck and shoulder pains which often lead to postural disorders and soft tissue shortenings. This study was done to compare the length of shoulder girdle’s muscles in healthy subjects and patients with shoulder and neck pain. Methods: This case-control study was done on16 patients with chronic neck- shoulder pain as cases and 15 healthy subjects as control group. Length of upper trapezius, pectoralis major and minor muscles was evaluated with functional tests. Also, the range of shoulder abduction and external rotation and cervical flexion and lateral flexion were measured by goniometer. Results: Significant differences between patient and control groups were found in pectoralis major and minor muscles length in involved side (P<0.05) and also in neck active range of lateral flexion (P<0.05). Furthermore, there were significant differences between shoulder active range of abduction and external rotation (P<0.05) in the groups. Conclusion: This study confirmed a significant reduction in range of motion in the neck and shoulder and also a remarkably shortening in the muscles of in the involved side

The echocardiographic estimation of left ventricular filling pressures in patients with mitral valve stenosis

&quot;nBackground: Estimation of Left Ventricular End Diastolic Pressure (LVEDP) among patients with Mitral Stenosis (MS) helps to diagnose diastolic dysfunction and to explain their symptoms. However, Conventional Doppler measurements have limitation in predicting of LVEDP. This study sought to establish whether the correlation between measurements derived from Tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral stenosis. &quot;n&quot;nMethods: Thirty three patients with moderate to severe MS who had indication for left heart catheterization enrolled during 1387-88 in Imam Khomeini Hospital in Tehran, Iran. The mean diastolic transmitral pressure gradient and mitral valve area (MVA) were calculated, and Two-dimensional, M-mode, color Doppler and tissue Doppler Imaging indices such as: early diastolic mitral inflow velocity (E), annular early diastolic velocity (Ea), E/A ratio, Isovolemic relaxation time (IVRT), Pulmonary Vein systolic and diastolic flow velocities, Velocity Propagation, LA size, TE-Ea, Tei Index were obtained in maximum three hours before cardiac catheterization. The echocardiography analysis was performed offline without knowledge of hemodynamic data Linear correlation and multiple linear regression were used for analysis. p&amp;lt; 0.05 was considered significant. &quot;n&quot;nResults: In univariate analysis, E/Ea was associated with LVEDP significantly (p = 0.04, r = 0.38). There was also a significant correlation between TE-Ea and LVDP (p = 0.01, r = -0.44). In multiple linear regression Tei Index (&amp;szlig; = 0.4, p&amp;lt; 0.02), and TE-Ea (&amp;szlig; = 0.5, p = 0.02) were showed as independent predictors of LVEDP (R2 = 49%). &quot;n&quot;nConclusion: Although we observed a moderate correlation between Doppler measurements and LVEDP in patients with severe MS, more similar studies are required

Spatial Pattern Determination of Biodiversity Threats at Landscape Level (Case Study: Golestan Province)

Mapping spatial patterns of potential biodiversity threats is one of the important steps for effective conservation planning and activities. To determine the spatial patterns of threats in Golestan province, 12 criteria in four main groups including structural (fractal coefficient of perimeter, circularity ratio of area, average slope), compositional aspects of biodiversity (presence of species at risk), non-biological threats (distance to city, distance to village, distance to road, distance to infrastructure, distance to agricultural land, soil pollution, risk of fire) and isolation (Nearest Neighbor Index) were used. These data layers were digitized in GIS environment and were weighted through Analytical Hierarchy Process. A weighted linear combination was then used to map the spatial pattern of biodiversity threats in the province. Compositional aspect (0.59), non-biological threats (0.23), isolation (0.11), and structural aspect (0.07) were relatively weighted in the order of importance. Central parts of the province and patches in the northern and southern parts were recognized to be more exposed to biodiversity threats. The central parts of the province were mostly threatened by urban, industrial, road and agricultural development, whereas the northern and southern parts were recognized as areas of conservation importance having a variety of threatened birds

Cost Effectivness Of Inteligent Liver Function Test(ILFT) For Investigating Patients With Abnormal Liver Function Test

Objectives: Liver function tests are widely used by GPs in UK. Abnormal results from these tests(ALFTs) are common, and are either left uninvestigated further– potentially overlooking curable liver disease which would otherwise be fatal, or associated with a lengthy process of retesting, referral, costing both the patient and the health services time and resources. iLFT is a semi-automated liver test cascading system with a structured diagnostic algorithm to maximise the efficiency of requesting LFTs. This study undertook a cost-effectiveness analysis of the iLFT decision tool compared to routine practice in Scotland, UK. Methods: An economic evaluation alongside the trial, and lifetime model undertaken from the perspective of NHS of Scotland. A step wedge design trial was carried out which compared effect before and after intervention. Within trial outcomes are reported as incremental cost per correct diagnosis at six months follow up, while a Markov model was used to extrapolate out to a life-time analysis of costs and quality adjusted life years gained in each arm, to account for early detection of Alcoholic Liver Disease(ALD) and Non-Alcoholic Liver Fatty liver Disease(NAFLD). Results: The within trial analysis found costs to be £ 198.99 (95%CI 180.05, 217.94) and £260.14 (95%CI 190.93, 329.35) in routine practice and iLFT arms respectively. Probability of correct liver diagnosis was 0.41 (95%CI 0.37,0.46) in routine and 0.94 (95%CI 0.88,0.99) in iLFT, resulting in an ICER of £117.59 (95%CI 88,126) . The lifetime model found an incremental QALY gain of 0.99(95%CI .0843, .115) and a decreased cost of -31227.6(95%CI -31655.38, -30957.55at) , resulting in an ICER of £-312872. Conclusions: iLFT has a higher correct diagnosis rate and cost in short-term, in life-time model it dominates

Levels and variability of metals in soils of the province of Golestan (Iran)

Studying the concentration distribution of metals is necessary for soil pollution monitoring and maintaining environmental quality. To date, very little large-scale research has been performed to investigate metal contamination in developing countries. In this study, the content and spatial distributions of five metals (cadmium [Cd], copper [Cu], nickel [Ni], lead [Pb], and zinc [Zn]) were quantified based on 346 topsoil samples from 12 districts in the province of Golestan (northeast [NE] Iran). The concentration levels (mg/kg) of Cd, Cu, Pb, Ni and Zn varied from 0.02 to 0.36, 9.3 to 93.7, 6.8 to 44, 9.5 to 85.35, and 25 to 417.4, respectively. The average concentrations (mg/kg) obtained were as follows Cd 0.12 ± 0.07, Cu 23.9 ± 9.07, Ni 34.88 ± 11.59, Pb 15.42 ± 5.81 and Zn 82.08 ± 30.87. Significant differences in the distribution of trace elements among districts were detected. The AzadShahr and BandarGaz districts displayed the highest metal concentrations. Greater metal values were obtained in the central, south, west, and NE areas, although Zn concentration was also high to the north of the province. Values of contamination factor and contamination degree indicated that the metal pollution level was on the order of Zn > Cd > Pb > Cu > Ni and that all of the metals belonged to a low or moderate pollution category. Ni and Cu levels derived from natural sources, whereas Cd, Pb, and Zn derived from anthropogenic activities with greater mean concentrations than reference concentrations. © 2014 Springer Science+Business Media New York

Ticagrelor removal by CytoSorb® in patients requiring emergent or urgent cardiac surgery: a UK-based cost-utility analysis

Background: Acute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery.Objective: The aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK.Methods: A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters.Results: In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators—delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53–77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit.Conclusions: The implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use

Ticagrelor removal by CytoSorb® in patients requiring emergent or urgent cardiac surgery: a UK-based cost-utility analysis

Background: Acute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery.Objective: The aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK.Methods: A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters.Results: In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators—delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53–77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit.Conclusions: The implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use