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Tara Nazareth,1 Erin M Hart,2 Sarah M Ronnebaum,3 Sandhya Mehta,4 Dipen A Patel,3 Ina Kötter5 1Amgen Inc., Thousand Oaks, CA, USA; 2Pharmerit - an OPEN Health Company, New York, NY, USA; 3Pharmerit - an OPEN Health Company, Bethesda, MD, USA; 4Celgene Corporation, Summit, NJ, USA; 5Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg Eppendorf and Clinic for Rheumatology and Immunology, Bad Bramstedt, GermanyCorrespondence: Dipen A PatelPharmerit - an OPEN Health Company, Bethesda, MD, USATel +1 240-821-1270Email dpatel@pharmerit.comObjective: Oral ulcers are the cardinal manifestation in Behçet’s disease (BD). The 2018 European League Against Rheumatism (EULAR) recommendations describe treatments for BD-associated oral ulcers with mucocutaneous involvement; however, little comparative effectiveness information for these agents is available. In the absence of head-to-head trials, an indirect treatment comparison (ITC) could provide useful evidence regarding comparative effectiveness of BD treatments. The purpose of this study was to conduct a comparative systematic literature review (SLR) and similarity assessment of randomized controlled trials (RCTs) investigating the oral ulcer-related efficacy outcomes of EULAR-recommended treatments for BD-associated oral ulcers to determine the feasibility of an ITC.Methods: An SLR was performed to identify relevant RCTs indexed in MEDLINE/Embase before May 29, 2019. RCT similarities for the ITC were assessed based on a step-wise process recommended by the International Society for Pharmacoeconomics and Outcomes Research.Results: In total, 317 articles were identified, of which 14 RCTs, reflecting 11 EULAR-recommended treatments, were evaluated in a similarity assessment. Number of oral ulcers, resolution of oral ulcers, and healing time for oral ulcers were identified as the possible oral ulcer-related outcomes. After completing the similarity assessment of these outcomes, it was determined that a robust ITC was infeasible for the three oral ulcer-related outcomes due to heterogeneity in outcomes reporting, study design, and/or patient characteristics. More broadly, the results underscore the need for and consistent use of standardized measures for oral ulcer outcomes to facilitate comparative research.Conclusion: In the absence of head-to-head RCTs and infeasibility of quantitative ITC, comparative assessments for BD-associated oral ulcers are limited, including comparative effectiveness and cost-effectiveness evaluations. Healthcare decision-makers must continue to base treatment decisions on the extent and strength of available evidence (eg, robust RCTs), clinical guidelines, real-world experience, and patient considerations.Keywords: Behçet syndrome, oral ulcer, comparative effectiveness research

Rayo Morfín-Otero,1,2 Martha Alvarado-Ibarra,3 Eduardo Rodriguez-Noriega,1,2 Jesus Resendiz-Sanchez,4 Dipen A Patel,5 Jennifer M Stephens,5 Manuela Di Fusco,6 Carlos F Mendoza,6 Claudie Charbonneau7 1Institute of Infectious and Experimental Pathology, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico; 2Division of Infectious Diseases, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico; 3Hematology Service, National Medical Center ‘November 20’, Mexico City, Mexico; 4Laboratory of Mycology, Children’s Hospital of Mexico, Mexico City, Mexico; 5Pharmerit International, Bethesda, MD, USA; 6Pfizer Inc, Mexico City, Mexico; 7Pfizer International Operations, Paris, Île-de-France, France Background: Patients receiving allogeneic hematopoietic stem cell transplantation (alloHSCT) are at high risk of invasive fungal infections (IFIs), which are associated with high mortality and economic burden. The cost-effectiveness of prophylaxis for the prevention of IFIs in alloHSCT recipients in Mexico has not yet been assessed. Methods: This analysis modeled a hypothetical cohort of 1,000 patients to estimate costs and outcomes for patients receiving prophylaxis for IFIs following alloHSCT, from the perspective of institutional payers in Mexico. The main prophylaxis agents currently used in Mexican clinical practice are voriconazole, fluconazole, and amphotericin B (AmB). The model accounted for event rates of IFIs during each treatment, assuming IFI causality due to invasive aspergillosis, invasive candidiasis, or other IFIs, and that the outcome for patients during follow-up was IFI-related death, death from other causes, or survival. Clinical efficacies were obtained from published literature; costs were based on local sources. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Univariate (assessing the impact of varying each model parameter) and probabilistic sensitivity analyses were performed. Results: Voriconazole was associated with the lowest number of breakthrough IFIs, IFI-related deaths, and total number of deaths. Total costs were lower for fluconazole (Mexican pesos [MXN] 72,944; US $4,079) than voriconazole (MXN 101,413; US $5,671) or AmB (MXN 110,529; US $6,180). Voriconazole had better clinical outcomes and lower costs than AmB and could be considered cost-effective compared with fluconazole in line with the local ICER threshold. Drug costs, monitoring costs, and duration of prophylaxis were most sensitive to variation from univariate sensitivity analysis. Findings from the probabilistic sensitivity analysis were consistent with the base-case results. Conclusion: Voriconazole had the most favorable clinical outcomes, but overall prophylaxis costs were higher than with fluconazole. Overall, based on local ICER thresholds (MXN 184,665; US $10,326), voriconazole was considered a cost-effective option for prophylaxis of IFI in Mexico. Keywords: allogeneic hematopoietic stem cell transplantation, triazole, invasive aspergillosis, invasive candidiasis, incremental cost-effectiveness ratio, prophylaxis

Dipen A Patel,1 Andre Michel,2 Jennifer Stephens,1 Bertram Weber,3 Christian Petrik,4 Claudie Charbonneau5 1Health Economic and Outcomes Research, Pharmerit International, Bethesda, MD, USA; 2Klinikum Hanau GmbH, Hanau, Germany; 3Health Technology Assessment and Outcomes Research, 4Anti-infectives, Pfizer, Berlin, Germany; 5Pfizer International Operations, Pfizer France, Paris, France Background: Across Europe, methicillin-resistant Staphylococcus aureus (MRSA) is considered to be the primary cause of nosocomial pneumonia (NP). In Germany alone, approximately 14,000 cases of MRSA-associated NP occur annually, which may have a significant impact on health care resource use and associated economic costs. The objective of this study was to investigate the economic impact of linezolid compared with that of vancomycin in the treatment of hospitalized patients with MRSA-confirmed NP in the German health care system. Methods: A 4-week decision tree model incorporated published data and expert opinion on clinical parameters, resource use, and costs (2012 euros) was constructed. The base case first-line treatment duration for patients with MRSA-confirmed NP was 10 days. Treatment success (survival), failure due to lack of efficacy, serious adverse events, and mortality were possible outcomes that could impact costs. Alternate scenarios were analyzed, such as varying treatment duration (7 or 14 days) or treatment switch due to a serious adverse event/treatment failure (at day 5 or 10). Results: The model calculated total base case inpatient costs of €15,116 for linezolid and €15,239 for vancomycin. The incremental cost-effectiveness ratio favored linezolid (versus vancomycin), with marginally lower costs (by €123) and greater efficacy (+2.7% absolute difference in the proportion of patients successfully treated for MRSA NP). Approximately 85%–87% of the total treatment costs were attributed to hospital stay (primarily in the intensive care unit). Sensitivity analysis yielded similar results. Conclusion: The model results show that linezolid is a cost-effective alternative to vancomycin for MRSA-confirmed NP, largely attributable to the higher clinical response rate of patients treated with linezolid. Keywords: cost-effectiveness, linezolid, vancomycin, nosocomial pneumonia, resistant, Staphylococcus aureus

Jennifer M Stephens,1 Xin Gao,1 Dipen A Patel,1 Bram G Verheggen,2 Ahmed Shelbaya,3,5 Seema Haider4 1Pharmerit North America, Bethesda, MD, USA; 2Pharmerit Europe, Rotterdam, The Netherlands; 3Pfizer Inc, New York, NY, USA; 4Pfizer Inc, Groton, CT, USA; 5Mailman School of Public Health, Columbia University, NY, USA Background: Previous economic analyses evaluating treatment of methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTI) failed to include all direct treatment costs such as outpatient parenteral antibiotic therapy (OPAT). Our objective was to develop an economic model from a US payer perspective that includes all direct inpatient and outpatient costs incurred by patients with MRSA cSSTI receiving linezolid, vancomycin, or daptomycin. Methods: A 4-week decision model was developed for this economic analysis. Published literature and database analyses with validation by experts provided clinical, resource use, and cost inputs on data such as efficacy rate, length of stay, adverse events, and OPAT services. Base-case analysis assumed equal efficacy and equal length of stay for treatments. We conducted several sensitivity analyses where assumptions on resource use or efficacy were varied. Costs were reported in year-end 2011 US dollars. Results: Total treatment costs in the base-case were lower for linezolid ($10,571) than vancomycin ($11,096), and daptomycin ($13,612). Inpatient treatment costs were $740 more, but outpatient costs, $1,266 less with linezolid than vancomycin therapy due to a switch to oral linezolid when the patient was discharged. Compared with daptomycin, both inpatient and outpatient treatment costs were lower with linezolid by $87 and $2,954 respectively. In sensitivity analyses, linezolid had lower costs compared with vancomycin and daptomycin when using differential length of stay data from a clinical trial, and using success rates from a meta-analysis. In a scenario without peripherally inserted central catheter line costs, linezolid became slightly more expensive than vancomycin (by $285), but remained less costly than daptomycin (by $2,316). Conclusion: Outpatient costs of managing MRSA cSSTI may be reduced by 30%–50% with oral linezolid compared with vancomycin or daptomycin. Results from this analysis support potential economic benefit and cost savings of using linezolid versus traditional OPAT when total inpatient and outpatient medical costs are evaluated. Keywords: economic model, OPAT, cost

Background and Aim: Laboratory assessment of sialic acid as a marker of microvascular complications can be a diagnostic tool for diabetes mellitus. Microalbumin is an established predictor of diabetic nephropathy. The study was undertaken to evaluate serum sialic acid and microalbumin levels and to correlate it with glycemic control in diabetic nephropathy patients. Material and Methods: Clinically diagnosed diabetic nephropathy patientsvisiting the medicine OPD (outdoor patient department) and NCD (Non-Communicable Disease) were selected for the study. This study included 75 subjectswith diabetes types 2 of which 44 were males and 31were females. Control includes a total of 75 out of which 49 Males and 26 females. Blood samples were analysed for the glucose, C-reactive protein, and sialic acid. Urine sample was analyzed for microalbumin and sialic acid. Results: The mean value of FBS was 161±53.2 mg/dl which was significantlyhigher than controls 81±5.2. The Sialic acid in subjects was 105±21 mg/dl which is higher than controls 51±6 mg/dl. The urine microalbumin level was found to be 96.5±17.2 in subjects, whereas 6.4±1.6 mg/dl was in controls. Serum Creatinine level in subjects was 8.75±2.05 mg/dl which was higher than subjects 0.8±0.3mg/dl. Serum Urea in diabetic nephropathy subjects was 93.5±15.4 mg/dl, which is positively higher than controls 30.8±7.1 mg/dl. Conclusion: Urine microalbumin is established as a potential marker for diabetic nephropathy. The correlation of serum sialic acid, urine microalbumin and serum creatinine proposed serum sialic acid as an accessory diagnostic marker for diabetic nephropathy. Estimation of sialic acid before microalbumin in diabetic patients helps assess glycemic control and identify the risk for nephropathy and other secondary complications of diabetes mellitus, which are the main causes of mortality and morbidity among type-2 diabetes mellitus patients.

Polymer nanocomposite coatings of solar photovoltaic cells that absorb solar ultraviolet (UV) radiation and convert it into visible and near-infrared (NIR) light can increase the operational lifetime and the energy efficiency of the cells. We report a polymer nanocomposite spectrum converting layer (SCL) made of colorless polyimide CORIN impregnated with the nanoparticles (NPs) of fluoride NaYF4 doped with three-valent ions of Europium at a molar concentration of 60%. The NPs were the nanocrystals (179 ± 35 nm in size) in thermally stable hexagonal beta-phase. The visible-NIR photoluminescence quantum yield of the nano-powder was ∼69%. The SCLs were applied using the open-air multi-beam multi-target pulsed laser deposition method to silicon heterojunction (SHJ), copper-indium-gallium-selenide (CIGS), and inverted metamorphic multijunction (IMM) solar cells. The cells were exposed to UV radiation from a 365 nm light emitting diode. The I–V characteristics of the cells were measured with a solar simulator using AM0 filter. The proposed SCLs improved the UV stability of all three types of the cells: the power degradation of SHJs and IMMs cells was stopped or slightly reversed and the degradation rate of CIGSs decreased by ∼25%. The proposed SCLs have great commercial potential, especially for applications to space power.

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Transparent luminescent solar concentrator (LSC) windows with edge-attached photovoltaic (PV) cells have the potential for improving building efficiency without compromising aesthetics and comfort. Optimization of such windows requires an inexpensive simulator for experimenting with various designs. We report, for the first time to the best of our knowledge, the simulator of a transparent LSC window in the form of a plastic container filled with a colloid of photoluminescent nanoparticles (NPs) in an organic solvent (1-propanol). The exemplary NPs were produced by ball milling of the powder of rare earth (RE)-doped phosphor NaYF4:Yb3+,Er3+ synthesized by the wet method. The NPs converted the ultraviolet (UV) solar spectrum into visible/near infrared (NIR) via spectral down-shifting and down-conversion (quantum cutting). With a photoluminescence quantum yield (PLQY) of the phosphor

We report, for the first time to our knowledge, on the polymer nanocomposite sunlight spectrum down-converters made by the concurrent multi-beam multi-target pulsed laser deposition (CMBMT-PLD) of phosphor and polymer in ambient air. Phosphor PLD targets were made of down-converting rare-earth (RE)-doped fluorides NaYF4:Yb3+,Er3+, and NaYF4:Yb3+,Tm3+ with a Stokes shift of 620 nm (from 360 to 980 nm), minimizing the effect of re-absorption. The phosphors were synthesized by the wet method. Polymer target was made of poly (methyl methacrylate) known as PMMA. Target ablation was conducted with 1,064 nm beams from an Nd:YAG Q-switched laser. Beam intensity was 2.8 × 1016 W/cm2 for both targets. The substrate was a microscope glass slide. Phosphor nanoparticles with a size ranging from 10 to 50 nm were evenly distributed in the polymer matrix during deposition. The nanoparticles retained the crystalline structure and the fluorescent properties of the phosphor target. There was no noticeable chemical decomposition of the deposited polymer. The products of laser-induced reaction of the polymer target with atmospheric gases did not reach the substrate during PLD. Post-heating of the substrate at ∼90°C led to fusion of separate polymer droplets into uniform coating. Quantum yield of the down-conversion polymer nanocomposite film was estimated to be not less than ∼5%. The proposed deposition method can find its application in making commercial-size down-converter coatings for photo-voltaic solar power applications.

Many diseases are associated with oxidative stress are caused by free radicals. Current research has been directed towards finding naturally occurring antioxidants of plant origin. The aim of the present study was to evaluate the in vitro antioxidant activities of methanolic extract of Lawsonia inermis L. bark (MELIB). The present study was carried out for determination of qualitative, quantitative phytochemical and in vitro antioxidant activity for scavenging of free radical DPPH, superoxide radical scavenging and lipid peroxidation. The bark extract is a rich source of secondary metabolites like flavonoids at a rutin equivalent 73.43±0.26%, polyphenol at a gallic acid equivalent 84.70±0.43%, tannins at a tannic acid equivalent 88.75±0.14% and terpenoids at a linalool equivalent 68.13±0.31. MELIB showed free radicals scavenging capacity by way of the DPPH method (6.93±0.51 to 62.63±0.10% inhibition), the superoxide radical scavenging method (1.82±0.41 to 57.11±0.18% inhibition) and the ferric chloride induced lipid peroxidation method (9.87±0.33 to 80.32±0.82% inhibition). The results obtained in the present study indicate that MELIB can be a potential source of natural antioxidants due to the presence of flavonoids, polyphenols, tannins and terpenoids.

Purpose: Breast or cervical cancer screening visits may present an opportunity to motivate mothers to have their daughters vaccinated against human papillomavirus (HPV). In preparation for a future intervention study, we sought to establish the feasibility of using these visits to identify women with at least one daughter in the appropriate age range for adolescent HPV vaccination. Methods: We conducted a cross-sectional mailed survey of women who had received breast or cervical cancer screening within the 6-18 months before the survey. The study was conducted at two diverse institutions: one serving a mostly black (54.1%) urban inner-city population and another serving a mostly white (87.5%) suburban population. Results: Our overall response rate was 28% ( n = 556) in the urban site and 38% ( n = 381) in the suburban site. In the urban site, the proportions of mothers completing mammography or Pap smear visits with HPV vaccine-eligible daughters were 23% and 24%, respectively. In the suburban site, the proportions of mothers completing mammography or Pap smear with at least one vaccine-eligible daughter were 41% and 26%, respectively. Conclusions: Women who undergo breast or cervical cancer screening in the two different demographic groups evaluated have at least one adolescent daughter at the appropriate age for HPV vaccination. An important implication of this finding in adolescent daughters of urban mothers is the potential use of maternal breast or cervical cancer screening encounters to target a potentially undervaccinated group. [ABSTRACT FROM AUTHOR]

Bypassing the lab and rapidly diagnosing patients right then and there has its limitations, but benefits of POC testing go beyond delivering timelier STI treatment. Complications should be fewer--and you'll no longer be treating noninfected women. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Data on near-elderly (ages 55-64) women's access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women's health insurance coverage in the United States and how it may influence their use of health care services. METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women's use of outpatient services, inpatient services, and prescription medication over a 2-year period. RESULTS: In 2002, 9.4% of near-elderly women in the United States were uninsured and 15.4% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost. CONCLUSIONS: The nature of a near-elderly woman's insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage. [ABSTRACT FROM AUTHOR]

Defects in the laryngopharynx following surgical excision of the tumors can be involving either part or full of the circumference of the lumen. The methods of reconstruction use skin or mucosal lined surface, which have their own merits and demerits. Advent of free flaps have given the surgeon choice of multiple flaps which could take their place instead of a gastric pull up which entails mediastinal dissection. The article reviews the methods available and discusses the relative merits and indications of these, in partial and full lumen reconstruction of the laryngopharynx. Loss of the capacity to speak is a grave morbidity associated with these procedures and there have been significant advances in the rehabilitation of speech after laryngectomy. The current status of the methods of speech rehabilitation is discussed in detail. The reader will at the end, be presented with an algorithmic approach to choose the method of reconstruction depending on the size and site of the defect, as practiced the authors′ service.

Abstract Introduction Iatrogenic arteriovenous fistula is a vascular condition that may result from coronary angiography. Many case reports have described arteriovenous fistula occurrence after coronary angiography using the transfemoral access route, but rarely as a complication of using the transradial approach. We report a rare case of a patient with arteriovenous fistula following transradial artery coronary angiography. Case presentation A 62-year-old Caucasian man underwent emergent coronary angiography using the right radial artery approach. One month after angiography, he discovered a turbulent sound near the access site. A right radial arteriovenous fistula was found upon duplex ultrasound investigation. The patient was treated conservatively. At 1-year follow-up, the arteriovenous fistula was unchanged and the patient remained hemodynamically stable and asymptomatic. Conclusion Iatrogenic arteriovenous fistula is a rare vascular complication of transradial artery coronary angiography. The natural history of arteriovenous fistula is benign and is thought to resolve spontaneously; therefore, a conservative approach, as opposed to surgical ligation, is recommended as the first-line treatment.

Abstract Background The National Kidney Foundation has formulated clinical practice guidelines for patients with chronic kidney disease (K/DOQI). However, little is know about how many patients actually achieve these goals in a dedicated clinic for chronic kidney disease. Methods We performed a cross-sectional analysis of 198 patients with an estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 and determined whether K/DOQI goals were met for calcium, phosphate, calcium-phosphate product, parathyroid hormone, albumin, bicarbonate, hemoglobin, lipids, and blood pressure. Results We found that only a small number of patients achieved K/DOQI targets. Recent referral to the nephrologist, failure to attend scheduled clinic appointments, African American ethnicity, diabetes, and advanced renal failure were significant predictors of low achievement of K/DOQI goals. Conclusion We conclude that raising awareness of chronic kidney disease and K/DOQI goals among primary care providers, early referral to a nephrologist, the exploration of socioeconomic barriers and cultural differences, and both patient and physician education are critical to improve CKD care in patients with Stage 4 and 5 CKD.