Treatment Costs Research Articles

Global Elimination of Hepatitis C Virus.

Hepatitis C virus (HCV) is predominantly transmitted through parenteral exposures to infectious blood or body fluids. In 2019, approximately 58 million people worldwide were still infected with HCV, and 290,000 deaths occurred due to hepatitis C-related conditions, despite hepatitis C being curable. There are substantial barriers to elimination, including the lack of widespread point-of-care diagnostics, cost of treatment, stigma associated with hepatitis C, and challenges in reaching marginalized populations, such as people who inject drugs. The World Health Organization (WHO) has set goals to eliminate hepatitis C by 2030. Several countries, including Australia, Egypt, Georgia, and Rwanda, have made remarkable progress toward hepatitis C elimination. In the United States, the Biden-Harris administration recently issued a plan for the national elimination of hepatitis C. Global progress has been uneven, however, and will need to accelerate considerably to reach the WHO's 2030 goals. Nevertheless, the global elimination of hepatitis C is within reach and should remain a high public health priority.

Impact of social determinants of health on hepatocellular carcinoma surveillance, treatment, and health care costs.

The impact of clinical factors and social determinants of health on treatment patterns and health care costs among patients with HCC is unknown. Using 100% Medicare Fee-For-Service claims and a commercial multipayor claims database, we identified patients diagnosed with HCC from January 1, 2017, to December 31, 2020. Surveillance receipt was defined 12 months prior to HCC diagnosis, whereas treatment and health care costs were assessed post-HCC diagnosis. Multinomial logistic regression was used to assess the association between demographics, social determinants of health, and surveillance or HCC treatment. Multivariable generalized linear regression was used to identify factors associated with total health care costs. Of the 32,239 patients with HCC (mean age 68 y, 67% male, 73% White), 70% received surveillance and only half (51%) received any treatment. Curative treatment receipt was higher among those with prior surveillance (24% with CT/MRI and 18% with ultrasound vs. 9% with no surveillance). Curative treatment was independently associated with HCC surveillance and inversely associated with Black race, lower education level, and diagnosis in the year 2020 (COVID-19 year). Higher health care costs were independently associated with Black race, low English proficiency, living alone, and diagnosis in 2018-2020, and inversely associated with CT/MRI-based surveillance. Race and social determinants of health were independently associated with curative treatment receipt and health care costs. Increasing access to high-quality HCC surveillance may improve treatment receipt and reduce health disparities among patients with HCC.

Novel sulfide-driven denitrification methane oxidation (SDMO) system based on SBR-MBfR and EGSB-MBfR

Traditional denitrification process consumes external organic carbon leading to an increase in treatment costs and carbon emission. A novel sulfide-driven denitrification methane oxidation (SDMO) system, which could simultaneously utilize CH4 and H2S in biogas as electron donors for denitrification to reduce the cost and carbon emission, has been successfully operated in two kinds of reactors SBR-MBfR and EGSB-MBfR for ∼ 200 days in this study. The performance and microbial community were explored meanwhile machine learning approach have been used for predicting the complex effects on SDMO’s denitrification efficiency. Result shows SBR-MBfR’s superior performance with the maximum nitrate removal efficiency > 90 % while the denitrification rates and biological activity were also better than EGSB-MBfR. The autotrophic denitrification (Auto-D) contributed 5 % much more for nitrate removal in SBR-MBfR than EGSB-MBfR while denitrification anaerobic methane oxidation (DAMO) was more prominent in EGSB-MBfR. Nineteen machine learning models were used for operation data training and random forest regressor was demonstrated to be the optimal model for predicting nitrate removal efficiency in SDMO. According to random forest regressor’s analysis, HRT presented the highest importance in affecting SDMO nitrate removal efficiency. After the introduction of biogas for domestication, Auto-D bacteria Thiobacillus was the dominant bacteria in both systems occupying > 20 % and the abundance would increase gradually from ∼ 20 % to ∼ 60 % as H2S content rising. A hidden positive correlation between DAMO bacteria Candidatus Methylomirabilis and Thiobacillus was uncovered by mantel test analysis here, implying the integrating of Auto-D and DAMO process for nitrate removal. This study not only provides insights into the novel SDMO technology but also offers a potential advancement in simultaneously low-carbon wastewater treatment and biogas utilization.

Estimated health benefits, costs, and cost-effectiveness of implementing WHO's sodium benchmarks for packaged foods in India: a modelling study.

Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India. We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%. In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2-0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0-2·4) million incident cardiovascular disease events, and 0·7 (0·4-1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4-6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2-20·1) million incident cardiovascular disease events, and 4·8 (2·8-6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective. Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise. WHO Country Office India.

Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study.

Excess dietary sodium is a leading cause of death and disability globally. Because packaged foods are a major source of sodium in many countries, including Australia, mandatory limits for sodium might improve population health. We aimed to estimate the long-term health and economic effect of mandating such thresholds in Australia. We used a multiple cohort, proportional, multistate, life table model to simulate the effect of mandating either the WHO global sodium benchmarks or the currently non-mandatory Australian Healthy Food Partnership (HFP) sodium targets. We compared maintaining the current sodium intake status quo with intervention scenarios, using nationally representative data on dietary intake, sodium in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study. The effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted annually at 3%. Compared with the status quo intervention, mandating the WHO benchmarks could be cost saving over the first 10 years (AUD$223 [95% uncertainty interval 82-433] million saved), with 2743 (1677-3976) cardiovascular disease deaths and 43 971 (26 892-63 748) incident cardiovascular disease events averted, and 11 174 (6800-16 205) HALYs gained. Over the population's lifetime, the intervention was cost effective (100·0% probability). Mandating the HFP sodium targets was also estimated to be cost effective (100·0% probability), but with 29% of the health benefits compared with the WHO benchmarks. Our modelling study supports mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Although making Australia's voluntary reformulation targets mandatory might save thousands of lives, mandating the WHO global benchmarks could yield substantially greater health gains. None.

As-Needed Pilocarpine for Radiation-Induced Xerostomia in Head and Neck Cancers.

This study aimed to evaluate the efficacy of as-needed pilocarpine for the management of radiation-induced xerostomia. Additionally, the study sought to assess the side effects associated with an as-needed regimen. A randomized, double-blinded, placebo-controlled crossover study was conducted on patients who had undergone radiation therapy for head and neck cancers and developed xerostomia. Participants took pilocarpine or placebo as needed for symptom relief at 2 weeks per treatment, which included a one-week washout period. The primary outcome measure was the severity of dry mouth symptoms, quantified using the Xerostomia Inventory (XI). The primary outcome was the change in the XI score. Among the 20 participants who completed the crossover study, there was a significant reduction in XI scores during the treatment phase with pilocarpine compared to the scores during the placebo phase. The mean difference in XI scores was -18.05 (95% CI: -17.17, -6.13, p < 0.001), with a-49.77 ± 3.22% change (p < 0.001). Only one participant withdrew due to pilocarpine side effects. As-needed pilocarpine administration is effective in relieving symptoms of radiation-induced xerostomia, with fewer side effects and reduced treatment costs compared to fixed-dose regimens. This study guides the potential shift toward flexible dosing strategies in clinical practice, promoting enhanced patient-centered, tailored care and adherence. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines Laryngoscope, 134:4542-4548, 2024.

Inclusive Exploration of Harmonizing and Alternative Treatments for Hypothyroidism

: A clinical syndrome known as hypothyroidism occurs due to a shortage of thyroid hormone as a result of decreased production, abnormal distribution, or no action of thyroid hormones. The most typical clinical symptoms included are dry skin, hair loss, weight gain, painful-prolonged periods, infertility, balance problems, slow speech, bradycardia, hypothermia, fatigue, anxiety &amp; depression, joint pain, and indigestion. Basically, age, gender, the severity of the ailment, and a few other factors affect the various signs and symptoms of hypothyroidism. The limitations of allopathic modalities necessitate the investigation of alternative treatment options. Future healthcare initiatives for the poor world will increasingly depend on CAM approaches to these concerns because lifestyle, diet, obesity, lack of exercise, and stress are significant contributing factors to the development of hypothyroidism. This review's objective is to provide information on herbs as well as complementary and alternative medications which are grouped into five major domains: Biologically Based therapies, Manipulative body-based therapies, Mind body-based therapies, and the whole Medical system. These have traditionally been used to treat thyroid dysfunction. The distribution of diseases in emerging nations is altering as a result of globalization. Hence the existing and potential roles of CAM techniques in the general practice of medicine are illustrated in these approaches. Scientists are being compelled to consider traditional herbal medical treatments and CAM therapy in order to combat adverse medication occurrences, high treatment costs, and compliance problems thus described in this review paper.

Cost-utility analysis of provision of e-cigarette starter kits for smoking cessation in emergency departments: An economic evaluation of a randomized controlled trial.

To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective. This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥8parts per million, attending the ED (n= 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS. Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups. The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%). The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds.

Machine learning technology for good health and well-being for sustainable human security in South Africa

The failure to achieve sustainable development in South Africa is due to the inability to deliver quality and adequate health services that would lead to the achievement of sustainable human security. As we live in an era of digital technology, Machine Learning (ML) has not yet permeated the healthcare sector in South Africa. Its effects on promoting quality health services for sustainable human security have not attracted much academic attention in South Africa and across the African continent. Hospitals still face numerous challenges that have hindered achieving adequate health services. For this reason, the healthcare sector in South Africa continues to suffer from numerous challenges, including inadequate finances, poor governance, long waiting times, shortages of medical staff, and poor medical record keeping. These challenges have affected health services provision and thus pose threats to the achievement of sustainable security. The paper found that ML technology enables adequate health services that alleviate disease burden and thus lead to sustainable human security. It speeds up medical treatment, enabling medical workers to deliver health services accurately and reducing the financial cost of medical treatments. ML assists in the prevention of pandemic outbreaks and as well as monitoring their potential epidemic outbreaks. It protects and keeps medical records and makes them readily available when patients visit any hospital. The paper used a qualitative research design that used an exploratory approach to collect and analyse data.

The WE-RISE™ multi-domain intervention: a feasibility study for the potential reversal of cognitive frailty in Malaysian older persons of lower socioeconomic status

BackgroundCognitive frailty (CF) is an emerging concern among older persons, particularly within lower socioeconomic statuses (SES) populations. Currently, there is limited evidence on the potential reversibility of CF through multi-domain interventions within this demographic. This study aimed to investigate the effectiveness of the WE-RISE™ multi-domain intervention in addressing the potential reversibility of CF among community-dwelling older persons of lower SES, the intervention effects on multiple health dimensions, and to determine if WE-RISE™ is of low cost.MethodsThis 24-week randomised controlled trial included 55 community-dwelling older persons of lower SES with CF, who were randomised into either the WE-RISE™ intervention group (n = 27), or the control group receiving usual care (n = 28). The WE-RISE™ intervention comprised of 12 weeks of instructor led, community-based intervention, followed by 12 weeks of WE-RISE™@Home. CF status, cognitive and physical function, nutrition, disability, health-related quality of life, exercise self-efficacy and depression were assessed at baseline, 12th and 24th weeks. Changes in CF status was analysed descriptively, while intervention effects were analyzed with split plot ANOVA. The cost of the WE-RISE™ intervention was calculated using activity-based costing.ResultsAt baseline, all participants in both the intervention and control groups (100%) were classified as CF. Following 12 weeks of the WE-RISE™ intervention, 74.1% of participants in the experimental group no longer met the criteria for cognitive frailty, with 63% maintaining this improvement at 24 weeks. In contrast, the CF status of participants in the control group remained largely unchanged, with only 10.7% showing improvement at 12 weeks and falling to 3.6% at 24 weeks. Significant intervention effects were observed for cognition, physical function, body composition, disability, health-related quality of life and self-perceived exercise self-efficacy (p < 0.05) following participation in WE-RISE™. The cost per intervention session was RM4.06 (≈ RM3.88), and the cost per subject for 48 sessions was RM194.74 (≈ RM187.01).ConclusionThe WE-RISE™ multi-domain intervention has demonstrated potential in reversing CF among older persons of lower SES, leading to significant improvements across multiple health dimensions at a low cost. WE-RISE™ shows promise to enrich the well-being of ageing societies, contribute to societal health, and ensure equitable access to healthcare, supporting broader implementation by enhancing equitable access to health programs and addressing the needs of older persons, WE-RISE™.Trial registrationThis trial was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619001055190) on the 29th of July 2019 – retrospectively registered.

An integrated environmental and economic assessment for the disposal of food waste from grocery retail stores towards resource recovery.

Food waste gives rise to many environmental problems. A large amount of food waste is produced by grocery retail stores. It is therefore important to apply efficient food waste treatment technologies with minimal environmental impact and investigate the optimal approach for food waste collection, transportation, and treatment. In the present study, a life cycle impact assessment (LCIA) was conducted to analyze different food waste disposal scenarios, including incineration, landfilling, composting, anaerobic digestion, and bioconversion. The impacts of the five scenarios on the environmental, economic, and social aspects were assessed. The results suggested that the landfilling scenario has the lowest net cost for the treatment of food waste, followed by the incineration scenario. The bioconversion treatment cost has the most significant positive effect on the net cost of the bioconversion scenario, and both the price and yield of compost have a significant negative effect on the net cost. The rankings of the five scenarios are the same under both weight determination methods, with the bioconversion scenario performing the best, followed by the composting scenario. The results of this study can help improve the disposal of food waste in grocery retail stores in the framework of sustainability and the circular economy.

Global techno-economic analysis of MBR for hospital wastewater treatment.

This study comprehensively examines and characterizes global membrane bioreactor (MBR) practices for hospital wastewater treatment, focusing on development trends, technical performance (pollutant removal and carbon emissions), and economic costs, including both capital expenditures (CAPEX) for civil engineering and equipment procurement, and operational expenditures (OPEX) for electricity, membrane replacement, labor, and chemical costs, as well as system footprint. The results show that MBR has been widely used for hospital wastewater treatment for over two decades, with global applications and scales significantly increasing, especially after the COVID-19 pandemic. A notable shift in membrane types has occurred, with hollow fiber membranes dominating before 2010 and flat inorganic membranes gaining prominence after 2020. MBR not only effectively removes conventional pollutants but also greatly reduces pathogens, ARBs and ARGs before disinfection, thus alleviating the subsequent disinfection burden. In addition, MBR is a crucial step in the process of completely removing emerging contaminants (ECs) that pose significant environmental and health risks. The CAPEX of MBR has decreased at the technical level in recent years. MBR requires only 62 % and 21 % of footprint for conventional activated sludge (CAS) and biofilm-based processes, respectively. MBR's land-saving advantage offsets the CAPEX gap with CAS in high land-cost areas. From before 2010 to after 2020, membrane costs saw the largest reduction in OPEX, dropping by 71 %, while electricity consumption saw a 10.71 % reduction, now comparable to biofilm-based processes. Currently, MBR's OPEX (0.158 USD/m3) is only slightly higher than that of biological contact oxidation (0.138 USD/m3). MBR also minimizes sludge production, reducing both treatment costs and associated disposal risks. MBR exhibit minimal concerns of excessive carbon emissions, with a carbon emission intensity (1.11 kg CO2eq·m-3), only slightly higher than biofilm-based processes (0.92 kg CO2eq·m-3). This study demonstrates that MBR is the valuable and practical solution for hospital wastewater treatment, as well as a preferred choice for upgrading existing facilities.

Telemedicine and telehealth

Regular hospital visits can be expensive due to travel costs, especially in rural areas. Fortunately, when telemedicine services are used through video conferencing or other virtual technologies, doctor visits can be reduced. Therefore, telemedicine saves the patient and the medical staff time and treatment costs. In addition, with its fast and efficient operations, it can simplify the workflow of hospitals and clinics. This innovative technology makes it easier to monitor discharged patients and manage their recovery. In conclusion, it is enough to say that telemedicine can create a win-win situation. The purpose of this article is to examine the main trends, treatment workflow characteristics, and barriers to the use of telemedicine in healthcare. As a new technology, telemedicine is preferred by large hospitals. With the development of Internet technology, digitization and information have been applied to telemedicine, but telemedicine still has many limitations due to many factors. This article summarizes the evolution of telemedicine. The development of telemedicine at home and abroad was discussed. The use of telemedicine was explored including the feasibility and limitations of commercialization and development. and provide a vision for the integration of these technologies into the medical field has resulted in the telephone, which is now available worldwide. This article presents telemedicine in three main areas, including current status, challenges and opportunities based on research and implementation. he integration of these technologies into the medical field has resulted in the telephone, which is now available worldwide. This article presents telemedicine in three main areas, including current status, challenges and opportunities based on research and implementation.

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis.

To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA). Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries. This review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes. KOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.

Cost minimization analysis of chronic kidney disease management: Evaluating economic strategies for early intervention and treatment optimization

Chronic kidney disease is a common global health condition characterized by progressive loss of kidney function and significant cost burden on the healthcare system worldwide. The disease often coexists with conditions such as diabetes and hypertension, further complicates its management and increasing associated costs. Effective economic management, particularly in the early stages of CKD, is crucial for reducing long-term healthcare expenses and improving patient outcomes. This review examines the utility of cost minimization analysis (CMA) as a strategic tool for evaluating economic options in CKD management. CMA is an economic evaluation method that compares the costs of different therapeutic interventions that have demonstrated equivalent clinical effectiveness, thereby aiding healthcare providers and policymakers in identifying the most cost-efficient options to optimize resource utilization. This review highlights the economic impact of CKD, focusing on the increasing costs linked to advanced disease management and the essential role of early diagnosis and intervention in reducing these costs and explores various cost-effective strategies for CKD management, including pharmacological treatments, lifestyle modifications, and patient education, to identify approaches that are both clinically and economically advantageous. Additionally, the broader implications of cost minimization for healthcare policy, clinical decision-making, and resource allocation are discussed for their significance in a resource-limited healthcare setting. Evidence indicates that prioritizing cost-effective CKD management through early intervention and preventive care can significantly lower healthcare expenditures, slow the disease progression, and enhance patient’s quality of life. By adopting such strategies, healthcare systems can achieve better clinical outcomes and ensure financial sustainability.

The association of osteoarthritis with metabolic disorders

Osteoarthritis (OA) is the most common form of synovial joint arthritis that causes chronic pain and disability to a large number of people worldwide. Most often, osteoarthritis affects the joints of the knees, hips, spine and hands. The Global Burden of Disease (GBD, 2021) estimates that osteoarthritis will be the fourth leading cause of disability by 2030, with enormous healthcare costs for treatment, as well as significant indirect costs due to loss of productivity and premature retirement. The aim of our research is to determine in what way prevalent metabolic syndrome is among participants with osteoarthritis of one of the synovial joints (knees, hips, hands), and whether metabolic disorders are a risk factor for the development and worsening of osteoarthritis. A prospective clinical study was conducted at the Public Health Institution Health Center Živinice, from July 2022 to May 2024, on a random sample of 200 participants with a confirmed clinical diagnosis of osteoarthritis (OA), who were divided into a group with metabolic syndrome and a group without metabolic syndrome based on the NCEP ATP III panel criteria for metabolic syndrome. The prevalence of knee osteoarthritis is significantly higher compared to the prevalence of hip and hand osteoarthritis, and it is greater among participants with a higher BMI (in participants with the highest BMI, knee osteoarthritis occurs with a 100% probability) and with the presence of metabolic syndrome, especially in more severe forms, specifically radiologically confirmed osteoarthritis, regardless of age and gender. Unlike OA knees the prevalence of OA hips and hands shows no correlation with BMI and metabolic syndrome. Multiple comparative analysis of differences in the average severity of osteoarthritis of the knee of subjects with normal glycemia / prediabetes / diabetes type 2 it showed a statistically significant difference in the average severity of knee osteoarthritis in subjects with regular blood sugar compared to subjects with prediabetes/diabetes mellitus type 2 regardless of age and gender. This means that with an increase in blood sugar levels, the degree of severity of osteoarthritis of the knee increases, since each subsequent Group has a higher average value of this indicator (p&lt;0.05; CI 95%).

Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital.

In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital. A retrospective review identified pediatric patients with isolated, closed, and acute (below 3wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs. Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital. Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden. Level III-therapeutic.

A Molecular Approach to Understand the Involvement of Mycoplasma in Suppurative Otitis Cases of Cattle in Chittoor District of Andhra Pradesh

In bovines the economic losses mainly due to the outbreak of diseases, leads to mortality, morbidity, treatment cost and reduced production. Recently in August month of 2024, received 13 bovine suppurativeotitis samples from outbreak in KuppamMandal of Chittoor district. The history having the purulent discharges with foul smell from ear infections of cattle that to crossbreed cattle of all age groups are affected. After 5 days of appearing aural discharges the animals were also shown the nervous signs, head tilting and other clinical findings includes unilateral or bilateral ear droop, epiphora, ptosis, abnormal nystagmus, strabismus, regurgitation, stiff neck, opisthotonus, facial hyperesthesia, purulent aural discharge, nasopharyngeal collapse, recumbency and finally death were noticed in severely affected animals. All the samples were processed for cultural tests by inoculating in PPLO selective broth and selective media PPLO agar then incubated anaerobically at 370C and observed the color development in broth pink to yellow color after 3- 5 days of incubation indicative of positive growth and fried egg micro colonies on selective PPLO agar media after 8-14 days of incubation observed under low power and 40X. The DNA was isolated from all the samples and screened for presence of Mycoplasma by targeting 16s rRNA gene and found that out of 13 samples 10 were positive for genus Mycoplasma and produced the predicted 280bp size product in all positive samples. The suppurativeotitis in cattle usually is caused by Actinomyces spp., Corynebacterium pseudotuberculosis, E. coli, Heamophilus, P.multocida, Pseudomonas spp, Streptococcus spp., and Mycoplasma bovis. This study was targeted only the emerging pathogen i.e the cellwall deficient bacteria Mycoplasma because of infections is hampered by a lack of effective vaccines and specific treatments, leads to increasing trends in antimicrobial resistance. Concluded that isolation and identification of the pathogenic ........

Cost-utility and clinical outcome analysis of surgery or oral corticosteroids treatment in patients with chronic rhinosinusitis with nasal polyps

Background: Surgery and oral corticosteroids are recommended therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) patients who are nonresponsive to intranasal corticosteroid treatment. Objective: This study aimed to compare the effectiveness of these 2 treatments in terms of improving sinus-related symptoms, enhancing quality of life, and economic costs and duration costs. Methods: This prospective study enrolled CRSwNP patients. All participants were instructed to complete the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale, and 36-item short-form (SF-36) questionnaire at baseline and 3 months after treatment. The nasal polyp score (NPS) was assessed via endoscopic examination. Additionally, patients were requested to maintain records of economic direct costs, other indirect costs, and duration costs throughout the 3-month period and to report them during each follow-up visit. Results: A total of 40 patients who underwent surgery or received oral corticosteroids were enrolled in this study. After 3 months of treatment, significant improvements were observed between baseline and 3 months after treatment in the NPS, total SNOT-22 score, and nasal congestion, runny nose, facial pain, olfactory function, and overall symptoms measured. Only headache and sleep order were improved in the surgery group. Both physical functioning and general health, as measured by the SF-36, improved after both treatments, and the role-physical, bodily pain, and social functioning domains of the SF-36 improved only in the surgery group. The changes in the NPS, nasal congestion, runny nose, olfactory function, and sleep disorders in the surgery group were greater than those in the oral corticosteroid group (P values = 0.0003, 0.0092, 0.0258, 0.0284, and 0.0164, respectively). Changes in the total SNOT-22 score and SF-36 subscores were not different between the 2 treatment groups. The direct economic costs and duration costs of surgical treatment were 4.5 times and 17.0 times higher, respectively, than those of oral corticosteroid treatment. Conclusions: Both surgical and oral corticosteroid treatments effectively improved clinical symptoms and quality of life in patients with CRSwNP. Patients who underwent surgery exhibited greater improvements in sinus-related symptoms. Nevertheless, oral corticosteroid treatment presented notable advantages in terms of economic cost and duration cost of disease-related care.

Incidence and clinical characteristics of cardiac amyloidosis in Tuscany and Umbria

Abstract Background Recent advances in imaging and increased disease awareness have led to a significant rise in newly diagnosed cases of cardiac amyloidosis (CA) over the past decade. However, there remains a lack of epidemiological data regarding the true incidence of the disease. Purpose To determine the incidence and clinical characteristics of newly diagnosed cases of CA in a large Italian population. Methods Subjects with suspected CA underwent diagnostic work-up in 20 Centers in Tuscany and Umbria regions within the Cardiac Amyloidosis RegistRY (CARRY), between January 1st 2022 and December 31st 2022. Results A total of 551 subjects were enrolled in the registry, with complete data on the final diagnosis available for 448 individuals. CA was diagnosed in 179 patients (40%), with 28 (16%) classified as light chain CA (AL-CA), 114 (64%) wild-type transthyretin CA (ATTR-CA), 12 (7%) variant ATTR-CA, and 25 (13%) undetermined CA. Considering a reference population in Tuscany and Umbria in 2022 (4,518,388, according to the Italian National Institute of Statistics), this yields an estimated cumulative incidence of 39.6 cases per million inhabitants per year. Alternative diagnoses in the remaining patients mostly included hypertensive heart disease (n=157, 58%), hypertrophic cardiomyopathy (n=25, 9%), moderate-to-severe valvular heart disease (n=11, 4%), or a mixed phenotype (n=72, 27%). The primary referral pathway for the suspicion of CA was cardiological (n=345, 77%), followed by incidental finding during screening visits (n=58, 13%), and haematology referral (n=33, 7%). Patients with confirmed CA were older (81 [75-85] vs. 77 [72-83] years, p&amp;lt;0.001), and more frequently reported musculoskeletal red flags of CA, such as carpal tunnel syndrome (85 [48%] vs. 53 [20%] years, p&amp;lt;0.001), and spontaneous tendon rupture (39 [22%] vs. 18 [7%] years, p&amp;lt;0.001). Median time to diagnosis from clinical suspicion was 73 (37-140) days for CA and 84 (36-156) days for alternative diagnoses (p=0.564). Conclusions The diagnosis of CA is on the rise globally, with an estimated incidence of 39.6 new cases per million inhabitants per year in two large regions of Italy. These findings should inform policymakers in redefining the status of CA as a rare disease, potentially influencing patient care and treatment costs.