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Aims Cost-effectiveness data on the remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) compared to the current standard of care (SC) remains limited. This meta-analysis was performed to assess the economic burden, and to develop an integrated economic model evaluating the efficiency of the RM strategy vs. SC in the context of French healthcare. Methods and results Randomized controlled trials, comparing RM to SC in patients implanted with ICDs with or without resynchronization therapy (±CRT-D), were identified through a systematic search of scientific literature databases dating from 2005. Seventeen trials (10 229 patients) reporting data on clinical outcomes, quality of life, cost, and/or utility, either as primary or secondary endpoints were identified. Compared to SC, RM resulted in significant reductions in annual costs per patient for direct healthcare costs (seven studies, difference in means −276.1, 95% standard error [SE]: 66.0, I2 = 76.3%) and for labour costs (two studies, difference in means −11.3, 95% SE: 1.4, I2 = 96.3%). A three-state Markov Model showed that RM resulted in cost-savings of €4142 per patient over a 5-year time horizon, with a quality-adjusted life year (QALY) gain of 0.29. The incremental cost-effectiveness ratio was −14 136 €/QALY, in favour of RM. Furthermore, probabilistic sensitivity analyses confirmed that the RM strategy was dominant over SC in 70% of cases. Conclusion Our economic model demonstrates that once implemented, RM of ICD ± CRT-D patients would result in increased effectiveness for lower costs over a 5-year period, compared to the current SC in France.

The pneumorachis or the presence of intraspinal air, is a rare entity of fortuitous discovery which can be of traumatic, infectious, iatrogenic origin or more rarely associated with a spontaneous pneumomediastinum. This pathology is usually asymptomatic, the air resolvesspontaneously and completely by passing into the bloodstream. Wereport a very rare case of cervico-dorsal pneumorachis complicatingspontaneous pneumomediastinum and cervical subcutaneousemphysema revealed by spinal pain and whose cause was a severeasthma attack.

DuringtheSARSCoV2pandemicchildrenappearlesslikelytodevelopsevereformComparedtoadultsubjectswithhighercontagiousnessandmortality,especiallyinthoseatrisk(ageover65obesitycardiovasculardiseasediabetes).HoweveranewmultisystemicinflammatorysyndromeassociatedwithSARSCoV2hasbeenidentifiedinthechildassociatedwithacascadeofinflammatoryresponseresponsibleforclinicalsymptoms(prolongedhighfeverdigestivedisordersrashcheiliteconjunctivit)andahighlydisturbedinflammatorybiologicalprofile(highCRPacceleratedsedimentationratehyperferritinemia)mimickinganatypicalpostcovid19Kawasakisyndromeinchildrenaswasrecentlypublished intheliterature. Ourcasewillillustrateanunusualpresentationofpostcovid19multisystemicinflammatorySyndrome acutepancreatitis ina9-year old with favorable clinical and biological development. &nbsp

Approximately 8-10% of metastatic colorectal cancer (mCRC) tumours harbour BRAF

Sara Khalife, Nisrine Bissar-Tadmouri Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli, LebanonCorrespondence: Sara KhalifeDepartment of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli, LebanonTel +961 70 557389Email sara.khalifeh@bau.edu.lbIntroduction: Factor V Leiden (G1691A), prothrombin (G20210A) and MTHFR (C677T) gene mutations were investigated in many studies for their association with Deep Venous Thrombosis.Case Presentation: A North Lebanese family has been examined, from an index case, a 40-year-old woman, who had a history of venous thrombosis with unexplained recurrent miscarriage. The index case was found to be heterozygous for factor V Leiden G1691A, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T gene variants. Her family members were heterozygous for at least two of the three-point mutations, and multiple risk factors associated with thrombophilia were identified.Conclusion: Our findings emphasize the need for clarifying the utility and futility of thrombophilia testing in the era of molecular diagnostics.Keywords: factor V Leiden G1691A, MTHFR C677T, prothrombin G20210A, deep venous thrombosis, recurrent pregnancy loss, Lebanese family

Introduction Factor V Leiden (G1691A), prothrombin (G20210A) and MTHFR (C677T) gene mutations were investigated in many studies for their association with Deep Venous Thrombosis. Case Presentation A North Lebanese family has been examined, from an index case, a 40-year-old woman, who had a history of venous thrombosis with unexplained recurrent miscarriage. The index case was found to be heterozygous for factor V Leiden G1691A, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T gene variants. Her family members were heterozygous for at least two of the three-point mutations, and multiple risk factors associated with thrombophilia were identified. Conclusion Our findings emphasize the need for clarifying the utility and futility of thrombophilia testing in the era of molecular diagnostics.

Measuring scientific outputs allows for objective evaluation of established health research systems and ranking countries according to scientific achievements. To our knowledge, attempts for systematic mapping health research output in the Eastern Mediterranean Region (EMR) are limited.We aimed to conduct a detailed bibliometric analysis of EMR biomedical and health research productivity during the period 2004-2013, considering country of first author.We applied an improved PubMed search strategy to obtain precise data on EMR research productivity, limiting articles to reviews, original research and case reports. Data were normalized to global research output, represented by total articles indexed in PubMed per year from 2004-2013, according to population size of each country. Second order polynomial trend lines were calculated and comparing 5-year periods: 2004-2008 with 2009-2013.Inspecting overall raw data, a clear increasing trend is observed. Regional share of global health related research ranged from 0.85-2.36% of total PubMed indexed publications during the study period. Five countries contributed to 80% of all published articles during study period; i.e., Islamic Republic of Iran (39%), Egypt (14%), Saudi Arabia (11%), Tunisia, and Pakistan (8% each). Overall, 2.35 articles are published per 100 000 population per year. While Kuwait maintained the highest per capita publication (followed by Tunisia, Lebanon, Qatar and Islamic Republic of Iran), Qatar, Islamic Republic of Iran and Saudi Arabia demonstrated the highest "per capita" population growth in publications. Three academic institutions accounted for over 10% of all publications that were led by an investigator from the Region. Collectively, most prolific 25 EMR institutions published 44% of all published biomedical and health research in the EMR.The overall global share of EMR health research publication is smaller than its global share of population or wealth. Biomedical and health research needs greater encouragement and supporting many EMR countries and/or institutions, especially those found to be least prolific in our analysis. The increase in academic publication on health has been more prominent in a few countries only. It is anticipated that the concentration of biomedical and health research in EMR academic institutions would help in translating knowledge into public health outcomes, if more suitable conditions are provided.جغرافيا البحوث البيوطبية والصحية في إقليم شرق المتوسط.غازي تدمري، أحمد منديل، آرش رشيديان.يتيح قياس المخرجات العلمية إجراء تقييم موضوعي لأنظمة البحوث الصحية وتصنيف البلدان وفقاً للإنجازات العلمية. حتى هذا الوقت فإن محاولات رسم خرائط منهجية للبحوث الصحية في إقليم شرق المتوسط تعتبر محدودة.تهدف الدراسة إلى إجراء تحليل ببليومتري مفصّل لمنشورات البحوث البيوطبية والصحية في إقليم شرق المتوسط خلال الفترة ما بين العامين 2004 و2013، مع الأخذ بعين الاعتبار أن يكون بلد المؤلّف الأوّل من الإقليم.قمنا بتطبيق إستراتيجية بحث محسّنة في قاعدة البيانات PubMed للحصول على بيانات دقيقة عن منشورات البحوث البيوطبية والصحية في إقليم شرق المتوسط. اقتصرت المنشورات التي خضعت للدراسة على المراجعات والبحوث الأصيلة وتقارير الحالات. تمّت معايرة البيانات حسب حجم مُْرَجات البحوث العالمية بالاستناد على إجمالي عدد المقالات المفهرسة سنويًا في قاعدة بيانات PubMed بين العامين 2004 و2013 وكذا وفقًا لحجم السكان في كل بلد. تم احتساب خطوط الاتجاه متعددة الحدود من الدرجة الثانية بمقارنة فترتين تمتدّ كلّ واحدة منهما على مدّة 5 سنوات: 2008–2004 مع 2013–2009.أظهرت البيانات الخام لمنشورات البحوث البيوطبية والصحية في الإقليم تزايداً تصاعدياً واضحاً. وساهمت خمس دول في الإقليم بحوالي 80٪ من إجمالي المقالات المنشورة خلال فترة الدراسة؛ إيران (39٪) ومصر (14٪) والمملكة العربية السعودية (11٪) وتونس (8٪) وباكستان (8٪). كما يتمّ نشر 2.35 مقالة لكل 100000 من سكّان الإقليم كل عام. كما يبدو أن للجامعات اليد العليا في انتاج البحوث البيوطبية والصحية في الإقليم؛ اليمن (85٪) ولبنان (84٪) وليبيا (76٪) وفلسطين (75٪) وتونس (72٪) والأردن (69٪). وساهمت 25 مؤسسة غزيرة الانتاج في إقليم شرق المتوسط مجتمعة بنشر ما يزيد عن 44٪ من إجمالي البحوث البيوطبية والصحية المنشورة في منطقتنا.يجب تشجيع البحوث الصحية ودعمها في العديد من بلدان و/أو مؤسّسات إقليم شرق المتوسط، لا سيّما تلك التي بيّنت الدراسة ضعف نتاجها العلمي. كما ينبغي أن يقترن هذا الدعم بتعزيز ثقافة استخدام الأدلة المستخلصة من البحوث في صنع السياسة الصحية.Géographie de la recherche en biomédecine et en santé dans la Région de la Méditerranée orientale.Mesurer la production scientifique permet d’évaluer objectivement les systèmes de recherche en santé établis et de classer les pays en fonction de leurs résultats scientifiques. À notre connaissance, les tentatives visant à cartographier de manière systématique la production de la recherche en santé dans la Région de la Méditerranée orientale sont limitées.Notre objectif consistait à réaliser une analyse bibliométrique détaillée de la recherche en biomédecine et en santé dans la Région de la Méditerranée orientale sur la période 2004-2013, en prenant en compte le pays du premier auteur.Nous avons employé une stratégie de recherche améliorée dans PubMed afin d’obtenir des données précises sur la productivité de la recherche dans la Région de la Méditerranée orientale, limitant les articles aux revues, aux recherches originales et aux études de cas. Les données ont été normalisées de manière à pouvoir être comparées à celles de la production de la recherche au niveau international, représentée par le nombre total d’articles indexés dans PubMed par année de 2004 à 2013, rapporté au nombre d’habitant de chaque pays. Des lignes de tendances polynomiales d’ordre 2 ont été calculées, avec une comparaison de périodes quinquennales : 2004-2008 avec 2009-2013.L’examen de l’ensemble des données brutes a permis d’observer une tendance croissante indéniable. La part de la Région dans la recherche en santé mondiale était comprise entre 0,85 % et 2,36 % du total des publications indexées dans PubMed au cours de la période étudiée. Cinq pays ont produit 80 % de l’ensemble des articles publiés pendant la période étudiée, à savoir la République islamique d’Iran (39 %), l’Égypte (14 %), l’Arabie saoudite (11 %), la Tunisie et le Pakistan (8 % chacun). Au total, 2,35 articles ont été publiés chaque année pour 100 000 habitants. Tandis que le Koweït conservait le nombre de publications par habitant le plus élevé (suivi de la Tunisie, du Liban, du Qatar et de la République islamique d’Iran), le Qatar, la République islamique d’Iran et l’Arabie saoudite ont enregistré la plus forte croissance de ce taux. Trois établissements universitaires représentaient plus de 10 % de l’ensemble des publications dirigées par un chercheur de la Région. Collectivement, les 25 établissements les plus prolifiques de la Région de la Méditerranée orientale ont publié 44 % de l’ensemble des articles de recherche en biomédecine et en santé publiés dans la Région.La part mondiale globale de la Région de la Méditerranée orientale dans les publications de recherche en santé est inférieure à sa part mondiale en termes de population ou de richesse. La recherche en biomédecine et en santé doit être davantage encouragée et un soutien doit être apporté à de nombreux pays et/ou établissements de la Région de la Méditerranée orientale, en particulier à ceux qui s’avèrent être les moins prolifiques dans notre analyse. L’augmentation du nombre de publications universitaires sur la santé a été notable dans quelques pays seulement. La concentration de la recherche en biomédecine et en santé dans les établissements universitaires de la Région de la Méditerranée orientale devrait aider à traduire les connaissances en résultats de santé publique, si des conditions plus favorables sont mises en place.

In COLUMBUS, treatment with encorafenib plus binimetinib in patients with advanced BRAF-mutant melanoma showed improved progression-free and overall survival with favourable tolerability compared to vemurafenib treatment. Here, results on health-related quality of life (HRQoL) are presented.COLUMBUS was a two-part, open-label, randomised, phase III study in patients with BRAF-mutant melanoma. In PART-I, 577 patients were randomised (1:1:1) to encorafenib plus binimetinib, encorafenib or vemurafenib. The primary objective was to assess progression-free survival. As a secondary objective, HRQoL was assessed by the EQ-5D, the EORTC QLQ-C30 and the FACT-M questionnaires. Furthermore, time to definitive 10% deterioration was estimated with a Kaplan-Meier analysis and differences in mean scores between groups were calculated with a mixed-effect model for repeated measures. Hospitalisation rate and the impact of hospitalisation on HRQoL were also assessed.Patients receiving the combination treatment showed improvement of their FACT-M and EORTC QLQ-C30 global health status scores, compared to those receiving vemurafenib (post-baseline score differences: 3.03 [p 0.0001] for FACT M and 5.28 [p = 0.0042] for EORTC QLQ-C30), indicative of a meaningful change in patient's status. Furthermore, a delay in the deterioration of QoL was observed in non-hospitalised patients compared to hospitalised patients (hazard ratio [95% CI]: 1.16 [0.80; 1.68] for EORTC QLQ-C30 and 1.27 [0.81; 1.99] for FACT-M) and a risk reduction of 10% deterioration, favoured the combination in both groups.The improved efficacy of encorafenib plus binimetinib compared to vemurafenib, translates into a positive impact on the perceived health status as assessed by the HRQoL questionnaires. The study is registered with ClinicalTrials.gov, number NCT01909453 and EudraCT number 2013-001176-38.

Background: In COLUMBUS, treatment with encorafenib plus binimetinib in patients with advanced BRAF-mutant melanoma showed improved progression-free and overall survival with favourable tolerability compared to vemurafenib treatment. Here, results on health-related quality of life (HRQoL) are presented. Methods: COLUMBUS was a two-part, open-label, randomised, phase III study in patients with BRAF-mutant melanoma. In PART-I, 577 patients were randomised (1:1:1) to encorafenib plus binimetinib, encorafenib or vemurafenib. The primary objective was to assess progression-free survival. As a secondary objective, HRQoL was assessed by the EQ-5D, the EORTC QLQ-C30 and the FACT-M questionnaires. Furthermore, time to definitive 10% deterioration was estimated with a Kaplan-Meier analysis and differences in mean scores between groups were calculated with a mixed-effect model for repeated measures. Hospitalisation rate and the impact of hospitalisation on HRQoL were also assessed. Results: Patients receiving the combination treatment showed improvement of their FACT-M and EORTC QLQ-C30 global health status scores, compared to those receiving vemurafenib (post-baseline score differences: 3.03 [p < 0.0001] for FACT M and 5.28 [p = 0.0042] for EORTC QLQ-C30), indicative of a meaningful change in patient’s status. Furthermore, a delay in the deterioration of QoL was observed in non-hospitalised patients compared to hospitalised patients (hazard ratio [95% CI]: 1.16 [0.80; 1.68] for EORTC QLQ-C30 and 1.27 [0.81; 1.99] for FACT-M) and a risk reduction of 10% deterioration, favoured the combination in both groups. Conclusion: The improved efficacy of encorafenib plus binimetinib compared to vemurafenib, translates into a positive impact on the perceived health status as assessed by the HRQoL questionnaires. (C) 2021 Elsevier Ltd. All rights reserved.

OBJECTIVE Recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT) with positive cytomegalovirus (CMV) serology are at increased risk of morbidity and mortality. The primary objective of this study was to assess the association between treated CMV infection and overall mortality within 1 year after allo-HCT in adult CMV-seropositive Recipients (R+). Secondary objectives included overall 5-year mortality after allo-HCT, risk factors for treated CMV infection, associations between treated CMV infection and allo-HCT complications and medical costs. METHODS A multicenter retrospective cohort study was conducted in adult CMV-seropositive recipients (R+) who underwent to allo-HCT between 1st January 2010 and 31st December 2014. RESULTS Five hundred seventy two CMV-seropositive patients (mean age, 50.2 years) undergoing allo-HCT between 2010 and 2014 were included; 55.9% of donors were CMV seropositive. CMV infection treated with antiviral therapy was reported in 227 patients (39.7%) after transplantation. One-year overall mortality was significantly increased in patients with treated CMV infections (hazard ratio, 1.86; 95% CI, 1.16-3.00; P = .011). Mean medical costs during the first post-HCT year were higher in patients with CMV infection (€46 853 vs €31 318; P