Random glucose sampling as screening tool for diabetes among disadvantaged tuberculosis patients residing in urban slums in India.

Recently, a two-step diagnostic algorithm to diagnose diabetes among TB patients was proposed comprising random glucose and point-of-care HbA1c. This study evaluates the first part of this algorithm among disadvantaged TB patients. http://ow.ly/UI7d30nK1UN

Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines

Objectives Patients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings. Design Cost-effectiveness analysis using Markov cohort model. Setting South Africa, Georgia and the Philippines. Participants XDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.InterventionsBPaL regimen. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral. Results BPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$3 million in South Africa, US$ 200 000 and US$60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs. Conclusions Our results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p  <0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p  <0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p  <0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training

CBCT based assessment of crestal bone loss in patients treated with mandibular implant over dentures: An original research study

Aim: The exclusive aim of this study was to assess of crestal bone loss in patients treated with mandibular implant over dentures. Authors utilized three dimensional diagnostic tool i.e. cone beam computed tomography (CBCT) for the study. Materials & Methods: The study was conducted in the department of Prosthodontics of the institute wherein systematic sampling procedure was done to select completely edentulous patients. Complete dentures were fabricated with standard manner with compression moulding technique and heat cure acrylic resin. Cone beam computed tomography was completed to assess the bone quality and quantity at desired locations. Total 6 male and 6 female patients were included in the study. Group I has the implants of the right side of the mandible and Group II has implant placed on the left side of the mandible. The twenty four implants were studied in detail for bone losses in post operative phases. at mesial, distal, buccal and lingual sides of the dental implants. P value less than 0.05 was considered significant (p< 0.05). Statistical Analysis and Results: Statistical analysis was completed by statistical software Statistical Package for the Social Sciences (SPSS).&nbsp

Budgetary impact of using BPaL for treating extensively drug-resistant tuberculosis.

INTRODUCTION: Bedaquiline, pretomanid and linezolid (BPaL) is a new all oral, 6-month regimen comprised of bedaquiline, the new drug pretomanid and linezolid, endorsed by the WHO for use under operational research conditions in patients with extensively drug-resistant tuberculosis (XDR-TB). We quantified per-patient treatment costs and the 5-year budgetary impact of introducing BPaL in Indonesia, Kyrgyzstan and Nigeria. METHODS: Per-patient treatment cost of BPaL regimen was compared head-to-head with the conventional XDR-TB treatment regimen for respective countries based on cost estimates primarily assessed using microcosting method and expected frequency of each TB service. The 5-year budget impact of gradual introduction of BPaL against the status quo was assessed using a Markov model that represented patient’s treatment management and outcome pathways. RESULTS: The cost per patient completing treatment with BPaL was US$7142 in Indonesia, US$4782 in Kyrgyzstan and US$7152 in Nigeria – 57$128 780) in XDR-TB treatment-related expenditure in Indonesia, 15% (US$700 247) in Kyrgyzstan and 32$1 543 047) in Nigeria. CONCLUSION: Our study demonstrates that the BPaL regimen can be highly cost-saving compared with the conventional regimens to treat patients with XDR-TB in high drug-resistant TB burden settings. This supports the rapid adoption of the BPaL regimen to address the significant programmatic and clinical challenges in managing patients with XDR-TB in high DR-TB burden countries

Budgetary impact of using BPaL for treating extensively drug-resistant tuberculosis

Introduction Bedaquiline, pretomanid and linezolid (BPaL) is a new all oral, 6-month regimen comprised of bedaquiline, the new drug pretomanid and linezolid, endorsed by the WHO for use under operational research conditions in patients with extensively drug-resistant tuberculosis (XDR-TB). We quantified per-patient treatment costs and the 5-year budgetary impact of introducing BPaL in Indonesia, Kyrgyzstan and Nigeria. Methods Per-patient treatment cost of BPaL regimen was compared head-to-head with the conventional XDR-TB treatment regimen for respective countries based on cost estimates primarily assessed using microcosting method and expected frequency of each TB service. The 5-year budget impact of gradual introduction of BPaL against the status quo was assessed using a Markov model that represented patient's treatment management and outcome pathways. Results The cost per patient completing treatment with BPaL was US$7142 in Indonesia, US$4782 in Kyrgyzstan and US$7152 in Nigeria - 57$128 780) in XDR-TB treatment-related expenditure in Indonesia, 15% (US$700 247) in Kyrgyzstan and 32$1 543 047) in Nigeria. Conclusion Our study demonstrates that the BPaL regimen can be highly cost-saving compared with the conventional regimens to treat patients with XDR-TB in high drug-resistant TB burden settings. This supports the rapid adoption of the BPaL regimen to address the significant programmatic and clinical challenges in managing patients with XDR-TB in high DR-TB burden countries