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A rapid point-of-care (PoC) test as an adjunct to blood culture to aid the diagnosis of sepsis patients with bloodstream infections may decrease the use of broad-spectrum antibiotics and reduce rates of inappropriate antimicrobial therapy (IAAT) use. Through a decision tree model, taking the perspective of the Irish healthcare provider, the cost-effectiveness of such an intervention was evaluated against the current standard of care (SoC) in hospitalized adults in Ireland. The base-case scenario showed that using a rapid PoC test was cost-saving and life-saving, with €8188 saved per death averted. The results were sensitive to the length of hospital stay for patients with true-positive and true-negative results and to the length of stay (LOS) in the intensive care unit. The threshold analysis showed that even at lower sensitivities, the rapid PoC test could be cost-effective due to the substantial impact of starting earlier targeted and appropriate treatment in patients with bloodstream infection (BSI) and sepsis.

Background: In terms of cancer mortality rates, hepatocellular carcinoma (HCC) ranks third. Direct-acting antiviral drugs (DAAs) had a profound impact on the treatment of hepatitis C virus (HCV). Objective: Understanding HCC frequency among cured HCV cases and to evaluate direct acting antiviral agents (DAAs) impact on occurrence of hepatocellular carcinoma among chronic hepatitis C patients who received these drugs. Subjects and methods: In a retrospective cross-sectional study we carried out this trial in Hepatitis Viruses' Treatment Unit, El-Ahrar Teaching Hospital, Egypt on 415 patients who received direct acting antiviral agents (DAAs) for treating chronic hepatitis C virus and achieved sustained virological response (SVR) between 2017 to 2022 where all file of cases fulfilled the inclusion as well as exclusion criteria. Result: HCC was significant in older age, male, DM, HTN and patient from rural residence. Platelet and albumin significantly decreased after HCC, but alpha fetoprotein, bilirubin, ALT, AST, serum creatinine and APRI score significantly increased after HCC. Conclusion: The incidence of HCC is highest among those who already have cirrhosis, and chronic hepatitis C is the leading risk factor of this condition. Direct anti-viral agents (DAAs) may play role in occurrence of hepatocellular carcinoma (HCC) in chronic hepatitis C patients who achieved sustained virological response (SVR). [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to design an Arabic computerized battery of cognitive skills for training children with specific learning disabilities (SLD).Subjects and methods: Nineteen students from fourth grade primary schools in Assiut, Egypt, who were previously diagnosed with SLD, agreed to participate in the rehabilitation program. The study passed through four stages: first stage, detailed analysis of the cognitive profile of students with SLD (n=19), using a previously constructed diagnostic cognitive skill battery, to identify deficits in their cognitive skills; second stage, construction of an Arabic computerized battery for cognitive training of students with SLD; third stage, implementation of the constructed training program for the students, each tailored according to his/her previously diagnosed cognitive skill deficit/deficits; and fourth stage, post-training re-evaluation of academic achievement and cognitive skills' performance.Results: Students with SLD have a wide range of cognitive skill deficits, which are more frequent in auditory cognitive skills (68.4%) than in visual cognitive skills (64.1%), particularly in phonological awareness and auditory sequential memory (78.9%). Following implementation of the training program, there was a statistically significant increase (P<0.001) in the mean scores of total auditory and visual cognitive skills, as well as in academic achievement (P<0.001) of the study group.Conclusion: Remediation-oriented diagnosis of cognitive skills, when tailored according to previously diagnosed cognitive deficits, leads to the improvement in learning abilities and academic achievement of students with SLD. [ABSTRACT FROM AUTHOR]

Background: Sperm cryopreservation is currently the only clinically available technique for preservation of male gametes for subsequent use in assisted reproduction technologies. Objective: The objective of this study was to determine the impact of semen cryopreservation on human sperm DNA. Patients and methods: The study sample consists of 20 male patients seeking seminal fluid analysis at the andrology laboratory of a specialized IVF center (ADAM International Hospital for Fertility and Sterility, Giza, Egypt), and accepting to sign a consent of approval to participate in the study, with the diagnoses of normozoospermia, oligozoospermia (either isolated or combined with asthenozoospermia or teratozoospermia). Results: There is no statistical difference between Pre-freezing and vitrification regarding DNA fragmentation, P>0.05. No statistical difference between Pre-freezing and slow frozen regarding DNA fragmentation, P>0.05. Finally, there is no significant statistical difference between vitrification and slow frozen regarding DNA fragmentation, P>0.05. Conclusion: The sperm DNA fragmentation index was not affected during cryopreservation under the various methods of storage tested. Clinicians and investigators should take this information into consideration when using cryopreserved sperm for assisted reproduction. [ABSTRACT FROM AUTHOR]

Background: Cryopreservation is the collection, freezing, and long term storage of sperm, and is a highly effective method of protecting male fertility. Cryopreservation of semen has been widely used as a vital method for fertility preservation of male patients before undergoing chemotherapy, radiotherapy, and/or surgery that may lead to testicular failure or ejaculatory dysfunction. Objective: The aim of this study was to compare the aseptic technology of cryoprotectant-free vitrification of human spermatozoa in large volume, to conventional freezing protocol as regards post thawing motility, vitality and sperm DNA fragmentation. Patients and methods: This study included a total of 20 male patients seeking seminal fluid analysis, attending at the andrology laboratory of a specialized IVF center (ADAM International Hospital for Fertility and Sterility, Giza, Egypt. Patients were presented with the diagnoses of normozoospermia, oligozoospermia (either isolated or combined with asthenozoospermia or teratozoospermia). Results: Motility of (in a large volume (300 μl) in the absence of permeable cryoprotectants displayed significant statistically lower levels as compared to conventional Sperm Freezing. It was shown in different groups at different times (post thawing and 1-hour and 24-hour) of assessment that motility of vitrified spermatozoa decreases in comparison with slow conventional freezing as we go from the baseline. DNA fragmentation of vitrified spermatozoa showed higher levels as compared to conventional slow freezing but there is no significant statistical difference between vitrification and conventional slow freezing in DNA fragmentation. Conclusion: It could be concluded that vitrification technique was quite far away from comparison with slow conventional freezing protocol, and still need for further modifications and wide scale of study to achieve the good results. [ABSTRACT FROM AUTHOR]

Objective: Data on osteoarthritis patients from the PRECISION trial were used to evaluate the cost-effectiveness of celecoxib (100 mg twice daily) versus ibuprofen (600-800 mg three times daily) and naproxen (375-500 mg twice daily). The perspective was that of the United Arab Emirates (UAE) healthcare system., Methods: Discrete-state Markov model with monthly cycles, 30-month horizon, and 3% discount rate was constructed to assess incremental costs per quality adjusted life year (QALYs) gained from reduced incidence of three safety domains examined in PRECISION: renal, serious gastrointestinal (GI), and major adverse cardiovascular events (MACE). Costs for managing these toxicities were derived from Dubai Administrative Billing Claims (2018). Median monthly drug costs were derived from UAE Ministry of Health and Prevention's published prices ($26.98 celecoxib; $20.25 ibuprofen; $20.50 naproxen). Health utility and excess mortality associated with toxicities were sourced from the literature. The willingness-to-pay thresholds used were 1 and 3 GDP per capita ($40,000-$120,000)., Results: The total average cost per patient was $812.88 for celecoxib, $775.26 for ibuprofen, and $731.17 for naproxen while cost components attributed to toxicities were lowest with celecoxib ($360.26, $438.31, and $388.60, respectively). Patients on celecoxib had more QALYs (1.339), compared with ibuprofen (1.335) and naproxen (1.337), resulting in an incremental cost-effectiveness ratio of $11,502/QALY gained for celecoxib versus ibuprofen and $39,779 for celecoxib versus naproxen. Probabilistic sensitivity analyses demonstrated celecoxib to be 81% cost-effective versus ibuprofen and 50% versus naproxen at $40,000/QALY. The most influential model parameters were MACE relative safety and drug costs., Conclusion: From UAE third payer perspective, celecoxib is a long-term cost-effective treatment for osteoarthritis patients when compared with ibuprofen, and equally likely as naproxen to be cost-effective. With the expected increasing burden of chronic diseases in the Gulf region, study findings can inform decisions regarding the cost-effective pain management of osteoarthritis in UAE., Clinicaltrialsgov Registration Number: NCT00346216., Competing Interests: Earlier versions of this analysis were presented at International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2020, USA as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” (Ahmed OH, Chirikov V, Walker C, Stephens JM, Schepman P, Chambers R, Bakir M, Poorman G, Haider S. Cost-Effectiveness of Celecoxib Versus Ibuprofen and Naproxen In Patients With Osteoarthritis In United Arab Emirates And Saudi Arabia Based On Results From The Precision Trial. Value in Health. 2020 May 1;23:S130. https://www.valueinhealthjournal.com/article/S1098-3015(20)30488-5/abstract). V Chirikov and J Stephens are employees of Pharmerit International - an OPEN Health Company. P Schepman and R Chambers are employees of Pfizer and may own stock options. M Bakir is an employee of Upjohn Export B.V. and may own sotck options. At the time of the study conduct, C Walker, G Poorman and S Haider were employees of Pfizer. Pharmerit International - an OPEN Health Company received funding from Pfizer to conduct the study. C Walker is now an employee of Viatris and may own stock options. The authors report no other conflicts of interest in this work., (© 2021 Chirikov et al.)