Cost-effectiveness analysis of tocilizumab in combination with methotrexate for rheumatoid arthritis: A Markov model based on data from Serbia, country in socioeconomic transition

Background/Aim. Recent studies have shown that biological treatments for rheumatoid arthritis can change the course of rheumatoid arthritis and improve functional ability of patients with rheumatoid arthritis. In spite of this fact, use of biological therapy is still limited by high prices of these medicines, especially in countries in socioeconomic transition. The aim of our study was to compare costeffectiveness of a combination of tocilizumab and methotrexate with methotrexate alone for rheumatoid arthritis in Serbia, a country in socioeconomic transition. Methods. For the purpose of our study we designed a Markov model using data on therapy efficacy from the available literature, and data on the costs of health states calculated from records of actual patients treated in the Clinical Center Kragujevac, Serbia. The duration of one cycle in our model was set at one month, and the time horizon was 480 months (40 years). The study was done from the social perspective, and all the costs and outcomes were discounted for 3% per year. Results. Treating rheumatoid arthritis with diseasemodifying antirheumatic drugs (DMARDs) alone was more cost-effective in comparison with a combination of biologic treatment with tocilizumab and DMARDs. The total costs for treating a patient with DMARDs for one year were on average 261,945.42 RSD, or 2,497.70 Euro and the total costs for treatment with tocilizimab plus DMARDs were on average 1,959,217.44 RSD, or 18,659.20 Euro. However, these results are susceptible to changes in costs and treatment effects of tocilizumab in patients with more severe forms of rheumatoid arthritis. Conclusion. Our results show that the use of tocilizumab for rheumatoid arthrits in economic environment of Serbia is not cost-effective. Use of tocilizumab for treating rheumatoid arthritis can become affordable, if costs of its use become lower. In order to start using expensive biologic medicines in patients in transitional countries, special strategy and pricing policy of international pharmaceutical companies are necessary, which would include calculation of prices of biologic medicines on the basis of local pharmacoeconomic studies

Značaj i upotreba žita u ishrani riba

Proizvodnja hrane za ribe, poslednjih godina beleži najbrži rast u industrijskoj proizvodnji hrane za životinje (Jovanović i sar. 2006). Ukoliko sektor akvakulture nastavi sa dosadašnjim prosečnim rastom od 8-10% godišnje do 2025. godine, i proizvodnja hrane moraće da prati taj rast (Tacon,2010). Danas se u hranu za ribe uglavnom uključuju riblje brašno i riblje ulje zbog visoke nutritivne vrednosti. Zbog ograničenosti prirodnih resursa. nameće se potreba za značajnijim uključivanjem biljnih hraniva, pre svega žita u ishrani riba. Žita prvenstveno predstavljaju izvor energije i služe za prihranu riba, međutim, njihovom preradom mogu se dobiti koncentati proteina koji se mogu koristiti kao delimična zamena za proteine animalnog porekla. Žita kao energetska hraniva čine osnovni deo obroka u poluintenzivnom sistemu gajenja riba. Proteinski deo potreba obezbeđuje im fauna dna i zooplankton. U našoj zemlji kukuruz je najvažnije žito koja se koristi u ishrani životinja. Visok sadržaj skroba, srazmerno velika zastupljenost ulja i malo celuloze, čini kukuruz izrazito energetskim hranivom (Đorđević i Dinić, 2007). Kukuruz karakteriše nizak sadržaj proteina sa nepovoljnim aminokiselinskim sastavom. Protein kukuruza pretežno čini zein koji ima nisku nutritivnu vrednost, pre svega usled deficita lizina i triptofana. Proteini ječma su niske biološke vrednosti, ali nešto bolji u odnosu na proteine kukuruza (Perović, Janković et al.,2009). Siromašni su u lizinu i metioninu, mada su selekcijom dobijene sorte sa većim sadržajem lizina. U poređenju sa kukuruzom, po hranljivoj vrednosti, pšenica sadrži više proteina, a manje masti. Sadržaj proteina kod različitih sorata pšenice varira od 10-14% (Protić, Janković,1998). Proteini pšenice su siromašni lizinom, zatim metioninom, treoninom, leucinom i izoleucinom (Janković et al.,2008). Količina lizina, koji je prva limitirajuća aminokiselina, iznosi 0,3-0,37%. Tritikale je hibrid pšenice i raži, koji se zbog relativno visoke nutritivne vrednosti sve više se koristi u ishrani svih kategorija životinja, pa i riba. Tritikale sadrži 11-20% sirovih proteina. Sadržaj aminokiselina je sličan sadržaju aminokiselina pšenice. Najsavremeniju tehnološku operaciju u procesu proizvodnje hrane za ribe predstavlja proces ekstrudiranja. Ekstruzionim kuvanjem na principu «visoka temperatura-kratko vreme» postižu se veca svarljivosti skroba, veća nutritivna vrednost, plutanje ili sporo tonjenje sto omogucava vece učesće žita u hrani za ribe. (Jovanović et al.2006).. Žita kao komponente u kompletnim smešama za ribe u intenzivnom uzgoju imaju izuzetno veliki značaj, posebno u ishrani šarana koji značajan deo energetskih potreba može zadovoljiti iz skroba. Proteinska hraniva, uz dodatak sintetičkih aminokiselina dobijena preradom žita, poput kukuruznog, pšeničnog glutena, kao i proteina pirinča, u značajnoj meri mogu zameniti, riblje brašno kao najkvalitetnije hranivo u ishrani riba. Selekcijom i genetskim modofikacijama treba stvarati žita sa povoljnim nutritivnim svojstvima potrebnim za hranu za ribe

Optimization and Kinetic Modelling of Total Phenols and Flavonoids Extraction from Tilia cordata M. Flowers

The main goal was to optimize and establish the kinetics and the thermodynamics of the extraction process. An investigation into the effects of ethanol  concentration (0–100 %), liquid to solid ratio (30–60 mL g–1), extraction temperature (25–65 °C), and extraction time (40–200 min) on the extraction of total  phenols (TP) and total flavonoids (TF) from linden (Tilia cordata M.) flowers was performed using single-factor experiments. Experimental results  showed that extraction conditions had a significant effect on the extraction of phenolic compounds. The optimized conditions were 50 % ethanol, liquid  to solid ratio 60 mL g–1 for 120 min at 55 °C, with values of 17.05 mg GAE g–1 dry weight (d.w.) for TP and 13.32 mg CE g–1 d.w. for TF. Extracted phenolic  compounds were analyzed by HPLC. The antioxidant activity of the extracts was evaluated by DPPH and ABTS assays. The applicability of different  mathematical models (model based for the unsteady diffusion through the plant material, model based on the film theory and model of Ponomaryov) to  describe the kinetics of the extraction process of TP and TF from linden flowers was studied as well. The mathematical models applied showed a good  agreement with the experimental results, which allows their application in modelling and optimizing the solid/liquid extraction process to extract TP and  TF from linden flowers.&nbsp

Promene agrohemijskih osobina pseudoglejnog zemljišta nakon izvedene kalcizacije

In the paper the results of evaluation effects of liming on the changes agrochemical soil properties are shown. The experimental part of trial was carried out on the pseudogley soil of strongly acid reaction and low availability of plant nutrients, during the three years period. The obtained results show that the use of lime together with the mineral and organic fertilizers resulted in the decrease of soil acidity for 0.9 pH units in H2O and 1.0 pH units in KCl. It also increased the phosphorus content for 4.3 mg 100-1 g of soil compared to the control variant, while the potassium content was not significantly changed. The humus content after the liming was redused by 0.217 % compared to the control.U radu su prikazani rezultati ispitivanja uticaja kalcizacije na promene agrohemijskih osobina zemljišta. Eksperimentalni deo ogleda izveden je na pseudoglejnom zemljištu jako kisele reakcije i slabe obezbeđenosti biljnim hranivima, u trajanju od tri godine. Dobijeni rezultati pokazuju da je primena krečnog materijala zajedno sa organskim i mineralnim đubrivom uticala na smanjenje zemljišne kiselosti, i to za 0,9 pH jedinica u H2O i 1,0 pH jedinica u KCl. Povećan je i sadržaj lakoristupačnog fosfora za 4,3 mg 100-1 g zemljišta u odnosu na kontrolnu varijantu, dok se sadržaj kalijuma nije značajnije promenio

Agricultural Extension and Advisory System in Sudan: a Review

Sudanese government attaches great importance to extension services. The review paper provides an overview on agricultural extension and advisory system (AEAS) in Sudan. It focuses on extension history, policy framework and governance, financing, human resources, gender, approaches and methods. In 1958, after Sudan’s independence, a national agricultural extension system was established. Extension services are almost entirely public. Main extension services providers are the federal Technology Transfer and Extension Administration (TTEA) and the General Directorate of Extension, Technology Transfer and Pastoralists’ Development. Moreover, each Sudanese federal state has a decentralised extension system. Sudan tried different extension approaches such as Commodity Development, Training & Visit and Farmers’ Field School. Primary extension methods include field visits, demos, workshops and field days. The main problem faced by Sudanese extension system is low extension workers’ number. It is crucial to strengthen linkages with agricultural research system and to improve coordination among institutions dealing with extension

Assessment of the chemical composition and in vitro antimicrobial potential of extracts of the liverwort Scapania aspera.

The chemical composition of Scapania aspera extracts was determined by solid phase micro extraction gas chromatography–mass spectrometry (SPME GC-MS) and 96 constituents were identified. The dominant compounds in the methanol extract were β-barbatene (25.1%), o-cymene (14.0%), α-barbatene (5.7%), allo-aromadendrene (4.9%) and β-bourbonene, while in the ethanol extract, o-cymene (17.8%), β-barbatene (17.6%), α-thujene (6.7%), octen-1-ol acetate (4.9%) and β-bazzanene (2.4%) were the major components. In the ethyl acetate extract, β-barbatene (14.3%), undecane (11.8%), 2-methyldecane (11.2%), decane (10.9%) and o-cymene (3.6%) were major components. The antimicrobial activity of the different extracts was evaluated against pathogenic and food spoilage microorganisms using disc diffusion and micro-broth dilution methods. The minimal inhibitory concentration (MIC) of extracts of S. aspera varied from 0.4 to 1.5 mg/mL and 1 to 3 mg/mL for yeast and bacterial strains, respectively. The zone of inhibition of the methanol extract for yeast strains was higher than that for bacterial strains. The results suggest that S. aspera extracts have potential as natural antimicrobial agents

WP4 ‐ Modernization of teaching contents 4.1. Need analysis for knowledge refreshment

This brochure is a result of the TEMPUS project “Building Capacity of Serbian Agricultural Education to Link with Society” (CaSA) 544072-TEMPUS-1-2013-1-RS-TEMPUS-SMHES (2013-4604/001-001). Daniela Šćepanović and Steve Quarrie were responsible for questionnaire construction, assisted by Slavica Čolić. Analysis of questionnaires was coordinated by Daniela Šćepanović, as well as final preparation and presentation of the results. For final document preparation, all CaSA Steering Committee members gave valuable contribution. For brochure final preparation Daniela Šćepanović, Vesna Poleksić and Goran Topisirović were in charge.TEMPUS Project: Building Capacity of Serbian Agricultural Education to Link with Society (CaSA) 544072-TEMPUS-1-2013-1-RS-TEMPUS-SMHES (2013 – 4604 / 001 - 001) Coordinator: University of Belgrade, Faculty of Agricultur

The association of demographic and socioeconomic determinants and self-perceived health

Introduction. Inequalities in health are evident in the whole world and present an important and consistent public health issue. The highest contribution to the inequality in heath is attributable to the demographic and socioeconomic determinants of health. Objective. The aim of this study was to analyze the association between the demographic (gender, age, marital status and type of settlement) and socioeconomic determinants of health (education and Wealth Index), and self-perceived health. Methods. In the study the data from 2006 National Health Survey of the population of Serbia were used. The interview involved 14,522 adults aged ≥20 years. The association between the demographic and socioeconomic determinants of health as independent variables, and self-perceived health as dependent variable were examined using bivariate and multivariate logistic regression analyses. The minimum level of significance was p<0.05. Results. According to our study, the elderly and females significantly more often perceived their health as poor. Respondents living in rural settings were less likely to perceive their health as poor compared to those living in urban settings (odds ratio was 0.82 in males and 0.75 in females). Males with low education were three times more likely to perceive their health as poor (odds ratio was 3.46) in relation to males with high education. This association was more pronounced in females (odds ratio was 5.37). The same pattern was observed for Wealth Index. Conclusion. This study showed that demographic and socioeconomic inequalities in self-perceived health are present in Serbia. Comprehensive public health policies and interventions for reducing these inequalities are urgently needed with the primarily focus on the most disadvantaged socioeconomic groups