Social accounting matrix and the effects of economic reform on health price index and household expenditures: Evidence from Iran.

Background: Socioeconomic indicators are the main factors that affect health outcome. Health price index (HPI) and households living costs (HLC) are affected by economic reform. This study aimed at examining the effect of subsidy targeting plan (STP) on HPI and HLC. Methods: The social accounting matrix was used to study the direct and indirect effects of STP. We chose 11 health related goods and services including insurance, compulsory social security services, hospital services, medical and dental services, other human health services, veterinary services, social services, environmental health services, laundry& cleaning and dyeing services, cosmetic and physical health services, and pharmaceutical products in the social accounting matrix to examine the health price index. Data were analyzed by the I-O&SAM software. Results: Due to the subsidy release on energy, water, and bread prices, we found that (i) health related goods and services groups' price index rose between 33.43% and 77.3%, (ii) the living cost index of urban households increased between 48.75% and 58.21%, and (iii) the living cost index of rural households grew between 53.51% and 68.23%. The results demonstrated that the elimination of subsidy would have negative effects on health subdivision and households' costs such that subsidy elimination increased the health prices index and the household living costs, especially among low-income families. The STP had considerable effects on health subdivision price index. Conclusion: The elimination or reduction of energy carriers and basic commodities subsidies have changed health price and households living cost index. Therefore, the policymakers should consider controlling the price of health sectors, price fluctuations and shocks.

Surface Microstructure of Two Bioceramics: Calcium-Enriched Mixture and Cold Ceramic in Setting Environments with Different pH Values.

Introduction: The pH of the setting environment could alter the surface characteristics of bioceramics. The present study aimed to assess the surface microstructure of calcium-enriched mixture (CEM cement) and cold ceramic (CC) in setting environments with different pH values. Materials and Methods: 12 dentin blocks with 3 mm height and internal diameter were prepared. CEM cement and CC were prepared and packed into the blocks. Samples in each bioceramics group (n = 6) were divided into 3 subgroups (n = 2) and exposed to acid, pH of 7.4, and alkaline pH for 1 week. Specimens were prepared for evaluation under a scanning electron microscope using backscattered electron (BSE) detectors. Monitoring of pH changes was rendered with a pH meter through the setting process. Results: BSE detection in an acidic environment showed more amorphous microstructures in CC specimens in comparison to CEM cement. In pH of 7.4 and alkaline pH, more unhydrated structures were observed in CEM cement compared with CC samples. During the first 48 h of the setting process, the pH changes of setting environments were more rapid in the CEM cement group in comparison to CC samples. Conclusion: pH changes during the setting process of cement could affect the surface microstructure and physical properties. In acidic environments, the crystallization of CC cement is more disrupted than that of CEM cement.

Physical therapy, intra-articular dextrose prolotherapy, botulinum neurotoxin, and hyaluronic acid for knee osteoarthritis: randomized clinical trial.

This study aimed to compare the efficacy of four treatments in the management of knee osteoarthritis. We carried out a randomized clinical trial with four study arms in an outpatient Department of Physical Medicine and Rehabilitation at a University Hospital. In total, 120 patients with knee osteoarthritis ≥50 years of age were randomly allocated to four groups. The primary outcome was knee pain in visual analog scale and the secondary outcome was the Knee Injury and Osteoarthritis Outcome Score. The exercise was prescribed daily for all participants throughout the study. For physical therapy (group 1), participants received superficial heat, transcutaneous electrical nerve stimulation and pulsed ultrasound. We administered a single intra-articular injection of botulinum neurotoxin type A (group 2) and three injections of hyaluronic acid (group 3) or 20% dextrose (group 4) to patients in the corresponding groups. Mixed analysis of variance showed that there was statistically significant difference between the groups in pain (P < 0.001), and Knee Injury and Osteoarthritis Outcome Score (P < 0.001). Pairwise between- and within-group comparisons showed that botulinum neurotoxin and dextrose prolotherapy were the most, and hyaluronic acid was the least efficient treatments for controlling pain and recovering function in patients. An intra-articular injection of botulinum toxin type A or dextrose prolotherapy is effective first-line treatments. In the next place stands physical therapy particularly if the patient is not willing to continue regular exercise programs. Our study was not very supportive of intra-articular injection of hyaluronic acid as an effective treatment of knee osteoarthritis.

Intra-articular botulinum toxin type A for treatment of knee osteoarthritis: Clinical trial.

In recent years, there is a growing interest in new medical applications of botulinum toxin, including pain control, osteoarthritis treatment, and wound healing. While clinical applications of botulinum toxin seem promising, existing evidence regarding the therapeutic effects is still inadequate. The aim was to assess the efficacy of a single injection of abobotulinumtoxin A into the knee joint cavity to reduce pain in elderly people. We carried out a single group clinical trial in a University Hospital. Thirty participants (24 women) more than 50 years of age with knee osteoarthritis were included. Diagnosis of osteoarthritis was based on clinical and radiologic findings. We gave a single injection containing 250 units of Dysport (= 100 units of botulinum neurotoxin type A) diluted with 5 ml of normal saline. The primary outcome measure was knee pain. The secondary outcome was the patients' opinion about their knee and associated problems measured with the Knee injury and Osteoarthritis Outcome Score. The outcomes were measured at the baseline and at 4 weeks after the intervention. Within-group comparisons based on the Knee injury and Osteoarthritis Outcome Scores showed favorable results for joint pain and stiffness, sports, severity of symptoms, quality of life, and daily activities (all p-values < 0.001). Also, pain intensity, joint effusion, knee clicking and locking, and flexion-extension scores showed significant beneficial results (all p-values ≤ 0.005). We concluded that botulinum neurotoxin type A is an effective and safe initial treatment of knee osteoarthritis with clear clinical advantages. Patients' satisfaction, minimum adverse effects in addition to single-dose prescription make the toxin as a choice for the first-line therapy of osteoarthritis at least at the short-term in elderly people. The symptom relief increases the patient's compliance and willing to participate in other therapeutic programs. REGISTRATION: Iranian Registry of Clinical Trials (IRCT) website http://www.irct.ir/, a WHO Primary Register setup, with registration code: Irct ID: IRCT20180416039323N1.

Linagliptin versus sitagliptin in patients with type 2 diabetes mellitus: a network meta-analysis of randomized clinical trials.

BACKGROUND: Diabetes is one of the most common chronic and costly diseases worldwide and type 2 diabetes is the most common type which accounts for about 90% of cases with diabetes. New medication-therapy regimens such as those containing linagliptin alone or in combination with other medications (within the category of DDP-4 inhibitors) must be evaluated in terms of efficacy and compared with other currently used drugs and then enter the medication list of the country. Hence, this study aimed to compare the clinical efficacy of the two drugs, i.e. linagliptin and sitagliptin, in patients with type 2 diabetes. METHODS: A systematic review was conducted to identify all clinical trials published by 2015 which compared the two drugs in patients with type 2 diabetes. Using keywords such as "linagliptin", "type 2 diabetes mellitus", "sitagliptin" and related combinations, we searched databases including Scopus, PubMed, and Web of Science. The quality of the selected studies was evaluated using the Jadad score. Considering primary and secondary outcomes extracted from the reviewed studies, a network meta-analysis was used to conduct a systematic comparison between the two studied drugs. RESULTS: This network meta-analysis included 32 studies (Linagliptin vs PLB: n = 8, Sitagliptin vs PLB: n = 13, Linagliptin + MET vs PLB + MET: n = 4, and Sitagliptin + MET vs PLB + MET: n = 7) and a total of 13,747 patients. The results showed no significant difference between linagliptin and sitagliptin in terms of key efficacy and safety outcomes such as HbA1c changes from baseline, body weight change from baseline, percentage of patients achieving HbA1c <7, and percentage of patients experiencing hypoglycemic events (p > 0.05). The results showed that the efficacy of the two drug regimens was the same. CONCLUSIONS: Based on the results, there was no significant difference between the two drugs, i.e. linagliptin and sitagliptin, in terms of efficacy; in other words, the efficacy of the two drugs was the same. Therefore, the use of these two drugs depends on their availability and cost. Graphical abstract of the network meta-analysis performed to evaluate the alternatives under the study.

A Cost-Utility Analysis of Different Antiviral Medicine Regimens in Patients With Chronic Hepatitis C Virus Genotype 1 Infection.

BACKGROUND: Despite the introduction of new drug regimens with high effectiveness for the hepatitis C virus (HCV) patients, especially in HCV genotype 1, no cost-effectiveness study on the selection of the superior drug strategy in Iran has been conducted yet. OBJECTIVES: This study is aimed to assess the cost-effectiveness of the three drug regimens of pegylated interferon and ribavirin (PR), sofosbuvir (SOF) + PR and ledipasvir and sofosbuvir (LDV/SOF) in patients with HCV genotype 1 in Iran in the year 2014. METHODS: A Markov micro-simulation model was used to evaluate the cost-effectiveness of the three drug strategies for a cohort of 10000 patients. Quality-adjusted life-years (QALYs) were extracted from published studies. Cost data was estimated through the review of medical records and obtaining experts opinion. RESULTS: The results showed that the SOF + PR drug compared with PR had a lower cost and was more effective, but compared with the LDV/SOF, in spite of its lower cost, it was less efficient. The QALY values obtained for PR, SOF + PR and LDV/SOF, respectively, were 10.98, 12.08 and 12.28 and their costs were $ 41,741, $ 7,676 and $ 46,993. Moreover, the results obtained from acceptability curves showed that SOF + PR were the most cost-effective treatment for thresholds below $ 45,270 PPP. CONCLUSIONS: The use of SOF + PR regimen or LDV/SOF can significantly reduce the incidence of complications associated with the disease. For example, short and long-term outcomes are better than the current drug regimens for HCV genotype 1 patients in all stages of the disease.

Utility of flexor carpi radialis h-reflex in diagnosis of cervical radiculopathy.

PURPOSE: The sixth and seventh roots are among the most common roots involved in cervical radiculopathy. The aim of this study was to evaluate the diagnostic value of flexor carpi radialis H-reflex in patients with suspected C6 or C7 root lesion. METHODS: This study was performed on 42 controls and 38 patients with suspected C6 or C7 radiculopathy. All patients were evaluated by physical examination, electromyogram, nerve conduction study and flexor carpi radialis H-reflex (superficial technique), and cervical magnetic resonance imaging. Side-to-side difference >1 millisecond or ipsilateral absent H-responses is considered as an abnormal response. Results were analyzed with SPSS. RESULTS: Specificity and sensitivity of H-reflex are 86% and 50% in C6 radiculopathy and 86% and 75% in C7, respectively. In six (54.5%) patients without electromyogram finding, flexor carpi radialis H-response was ipsilaterally abnormal. The mean of H-latency in control group was 15.7 (+/-1) milliseconds, and mean of side-to-side H-latency difference in this group was 0.43 (+/-0.39) milliseconds. CONCLUSION: Flexor carpi radialis H-reflex can be a helpful additional technique to routine needle electromyogram in the diagnosis of root lesions. The probability of abnormal flexor carpi radialis H-reflex in C7 root lesion is higher than that of C6 root lesion; however, it was not statistically significant.

Comparative study of the effects of gentamicin, neomycin, streptomycin and ofloxacin antibiotics on sperm parameters and testis apoptosis in rats.

The aim of this study was to investigate the comparative effects of aminoglycosides and fluoroquinolones on testis apoptosis and sperm parameters in rats. Fifty male Wistar rats were randomly divided into control (n = 10) and experimental (n = 40) groups. The experimental groups subdivided into four groups often. Each received 5 mg kg(-1) (IP) gentamicin, 50 mg kg(-1) (IP) neomycin, 40 mg kg(-1) (IP) streptomycin and 72 mg kg(-1) (IP) ofloxacin daily for 14 days, respectively; however, the control group just received vehicle (IP). In the fourteenth day, rats were killed and sperm analyzed for sperm parameters. Testis tissues were also prepared for TUNEL assay for detection of apoptosis. There was a significant decrease in sperm count, viability and motility in all of experimental groups when compared with control group. Although in streptomycin group these parameters were less decreased than in the other experimental groups. The apoptotic cells were significantly increased in all experimental groups when compared with those seen in the controlled group. Gentamicin, neomycin and streptomycin and ofloxacin have negative effects on sperm parameters and testis apoptosis in rats. However, these side effects are less seen in the streptomycin group. Therefore, it is recommended that usage of this drug have fewer side effects on male fertility.