An economic analysis of premarriage prevention of hepatitis B transmission in Iran

BACKGROUND: To assess the economic aspects of HBV (hepatitis B virus) transmission prevention for premarriage individuals in a country with cultural backgrounds like Iran and intermediate endemicity of HBV infection. METHODS: A cost-effectiveness analysis model was used from the health care system and society perspectives. The effectiveness was defined as the number of chronic HBV infections averted owing to one of the following strategies: 1) HBsAg screening to find those would-be couples one of whom is HBsAg positive and putting seronegative subjects on a protection protocol comprising HBV vaccination, single dose HBIG and condom protection. 2) HBsAg screening as above, in addition to performing HBcAb screening in the HBsAg negative spouses of the HBsAg positive persons and giving the protocol only to HBcAb negative ones. Sensitivity and threshold analyses were conducted. RESULTS: The cost of each chronic infection averted was 202$and 197$ for the strategies 1 and 2, respectively. Sensitivity analysis showed that strategy 2 was always slightly cheaper than strategy 1. The discounted threshold value for the lifetime costs of chronic liver disease, above which the model was cost saving was 2818$in strategy 1 and 2747$ in strategy 2. CONCLUSIONS: Though premarriage prevention of HBV transmission in the countries with cultural backgrounds similar to Iran seems cost saving, further studies determining precise costs of HBV infection in Iran can lead to a better analysis

A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer

BACKGROUND: Gastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran). The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients. METHODS: In this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day. RESULTS: No statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p < 0.003). Moreover, rebleeding rate was significantly lower in omeprazole group (15%) than in cimetidine group (50%) (p < 0.001). CONCLUSION: This study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074), shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization

Arterial stiffness, fatness, and physical fitness:Ready for intervention in childhood and across the life course?

International audienceA rterial distensibility and its converse stiffness have come of age as physiological concepts 1 and now as a target for intervention. The central hypothesis sustained so far is that an individual's "arterial stiffness" measured as aortic pulse wave velocity (PWV) is a convenient, integrated index of vascular pathology over a person's life course, more precise and reliable than other risk factors individually. For example, blood pressure (BP), whether casual or 24 hour, is more sensitive to stimuli and, therefore, more variable. Arterial distensibility is in part dependent on BP, yet its prognostic power is because of its "independence" from BP, including pulse pressure. 2 It appears to indicate the general burden of atherosclerotic disease and subclinical damage from multiple risk factors over time: the "wear and tear" of constant distension and recoil (part of "aging"), effects of smoking, lipid metabolism, (hyper)glycemia, ethnicity, how family history expresses itself, etc. 3 European hypertension guidelines now include PWV as a recommended but optional measure. The relationship of arterial distensibility with cardiac function and structure, known as aorto-ventricular coupling, is tantalizing because, as a bioengineering feedback loop, cause and effect are still unclear. Many other key questions remain, most critically related to the natural history of arterial stiffness but also fundamental ones of basic structural biology in the vessel wall. A clue to the natural history of arterial stiffness is published in this issue of Hypertension, an Australian study of 9to 10-year-old, generally prepubescent schoolchildren. 4 The study shows a clear relationship among degree of body fat, physical fitness, and arterial stiffness, measured by carotidfemoral PWV. The link of PWV with fitness was not independent of body fat. Why should this article be of interest, being only cross-sectional, whereby association may well not imply cause? The answer is its insight into primary prevention and underlying mechanisms. The study's strengths include its community base, large number of healthy children properly sampled, gold-standard "DXA" assessment of body composition, and an accepted method for PWV measurement. Its weaknesses include PWV measured sequentially rather than simultaneously at carotid and femoral sites over only 8 cardiac cycles. Another is the use of a 20-m shuttle run to assess cardiorespiratory fitness, which can be characterized by a variety of methods that the authors understandably could not apply but do not discuss or compare. Similarly, the pedometer is insensitive for assessing physical activity, especially in children, who may remove it. Perhaps as a result, only 20% of the variance of the PWV measured was related to any of their variables. However, these weaknesses would tend to bias the results toward the null so that any association with PWV was remarkable

CONSORT flow chart of the clinical trial comparing oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer in 80 Iranian patients

<p><b>Copyright information:</b></p><p>Taken from "A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer"</p><p>BMC Gastroenterology 2006;6():2-2.</p><p>Published online 11 Jan 2006</p><p>PMCID:PMC1360671.</p><p>Copyright © 2006 Khoshbaten et al; licensee BioMed Central Ltd.</p