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Editor’s Choice : Adalimumab and Etanercept in the Treatment of Rheumatoid Arthritis and Spondyloarthropathies: Budget Impact Model of Dose Reduction
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Abstract: Objective:To assess the financial impact ofspacing out the administration intervals of adalimumab (ADA) and etanercept (ETN) in the treatment of rheumatoid arthritis (RA) and spondyloarthropathies (SAP) in our work setting. Materials and method:A budget impact model (BIM) was developed to estimate the financial impact ofspacing out the usual administration intervals of ADA 40 mg every 2 weeks and ETN 50 mg weekly (scenario A) to ADA 40 mg every 3 weeks and ETN 50 mg every 2 weeks (scenario B), according to the guidelines and recommendations applied to these studies, specifying the target population, the study perspective, the time frame, and analysing the robustness of the study with a threshold univariate sensitivity analysis. Results:A total of 71 patients were included in the study.The application of a BIM showed annual savings for ADA and ETN of €19,784 and €38,271, respectively.The net cost, that is, the savings this entailed for the time frame considered (2 years), amounted to €116,110.The sensitivity analysis performed shows that the BIM estimated for the study period was very robust, as the net result in the different scenarios varied very little, remaining negative in the new scenarios. Conclusions:The BIM developed in the study shows the importance of the role of healthcare professionals in the context of sustainability of the healthcare system, where the model could generate large annual net savings for the different regional healthcare systems. Keywords: Rheumatoid arthritis, Spondyloarthropathies, Budget impact analysis, Adalimumab, Etanercept, Tumour necrosis factor alpha inhibitors.Download Full Article |
Editor’s Choice : Anthropometric Characteristics and other Dietary Aspects of a Group of Spanish Women Looking for Weight Loss and Enrolled in a Weight Management Program
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Abstract: Overweight is a health problem characterised as a higher than normal body weight due to an abnormal increase in body fat. Body weight adequacy is categorised using body mass index (BMI), however other parameters as fat mass (FM), waist circumference or waist to hip ratio, are relevant. Ideally, body composition should be calculated initially to evaluate changes during a dietary intervention for weight loss. Hunger experience is another parameter to take into account in order to succeed. The aim was to investigate and describe the characteristics of women seeking weight loss solutions. We organised an open program for people with body excess who wanted to lose weight. 252 women participated and answered to a dietary interview. Anthropometric measures of weight, height, body mass index, body fat, waist and hip circumference were taken. The mean age was of 36.84±7.29 years, and most of them, about 90%, have followed dietary programs for weight loss throughout their lives. They all wanted to lose weight in a range of 3 to 20 kilograms with a mean value of 11.49±6.01 kilograms. 123 women had a hunger profile of satiating behaviour and 129 a snacking one. The mean BMI was within overweight values, and mean fat mass was within obesity values. Waist and hip circumference were higher than normal in most of the participants and excess body weight perception and attitude were different. There is a need to tackle overweight and obesity individually, taking into account personal consciousness and expectancy, anthropometric measures and hunger experience. Keywords: Overweight, body mass index, fat mass, waist, hip, hunger, satiety.Download Full Article |
Editor’s Choice : Determination of Ground Water Quality for Agriculture and Drinking Purpose in Sindh, Pakistan
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Abstract: The study was conducted to assess the quality of ground water from different Talukas of district Tando Muhammad Khan for drinking and agriculture purpose. Water samples for determining the water quality were collected in one liter polyethylene bags by observing standard sample collection method. It was ensured that sample collection sites must be at least 500 feet away from each other.Physical and chemical parameters of ground and surface water samples such as pH, Electrical Conductivity (EC), Turbidity, Colour, Taste, Odour, Alkalinity as CaCO3, Bicarbonate (HCO3), Carbonate (CO3), Calcium (Ca), Magnesium (Mg), Hardness, Sodium (Na), Potassium (K), Chloride (Cl), Phosphate (PO4), Total Dissolved Solids (TDS) and Arsenic (As) were determined. The study clarified that pH and odour was within the permissible limits in majority of samples whereas, Arsenic (As),Hardness, Sodium (Na),Total Dissolved Solids (TDS), Taste, Chloride (Cl) and turbidity were beyond the permissible limits set by WHO. The groundwater status in Tando Muhammad Khan district, TDS in 50% samples, Chloride in 54.16% samples, Sulphate in 44.8% samples, Calcium in 38.5% samples, Sodium in 54.16% samples, hardness in 21.88% samples were beyond the WHO’s permissible limits for human consumption. Keywords: Ground water, physical composition, chemical composition.Download Full Article |
Editor’s Choice : Gastrografin Enemas for Treatment of Distal Intestinal Obstruction Syndrome in Children and Adults with Cystic Fibrosis
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Abstract: Background: Distal intestinal obstruction syndrome (DIOS) presents in both children and adults with cystic fibrosis (CF). When DIOS is characterized by bilious vomiting or when washout therapy with polyethylene glycol has failed, radio-opaque hypertonic enema (ROHE) is recommended as the next therapeutic option. Techniques for use of ROHE in infants with meconium ileus are described in the literature but have not been reported for children and adults with DIOS. Methods: We described the technique, volume, and results of Gastrografin enema usage for DIOS in children and adults with CF at our institution between 2006 and 2011. We reviewed the incidence of DIOS reported to the CF Foundation Patient Registry (CFFPR) between 2001 and 2011 Results: The mean amount of dilute Gastrografin used was 1220ml or 31 ml/kg, (range 240 - 3500ml; 19 – 59 ml/kg). Three patients had incomplete resolution after an initial enema and underwent repeat enemas on consecutive days. The incidence of DIOS in the CFFPR increased from 223 to 498 cases in children <18 years and 380 to 813 cases in adults >18 years over the ten year period studied. Conclusions: Large volume radio-opaque hypertonic enemas can resolve episodes of acute DIOS and can be repeated on subsequent days if needed, without complications. The incidence of DIOS reported to the United States CF Foundation Patient Registry has increased in both children and adults over the past decade. Keywords: Therapeutic intervention, radio-opaque hypertonic enema, DIOS.Download Full Article |
