Impacts of the Egyptian national screening and treatment programme for viral hepatitis C: A cost-effectiveness model.

BACKGROUND & AIMS: Egypt used to have one of the highest prevalences of HCV infection worldwide. The Egyptian Ministry of Health launched a national campaign for the detection and management of HCV to reduce its burden. This study aims to carry out a cost-effectiveness analysis to evaluate the costs and benefits of the Egyptian national screening and treatment programme. METHODS: A disease burden and economic impact model was populated with the Egyptian national screening and treatment programme data to assess direct medical costs, health effects measured in disability-adjusted life years and the incremental cost-effectiveness ratio. The scenario was compared to a historical base case, which assumed that no programme had been conducted. RESULTS: Total number of viremic cases is expected to decrease in 2030 by 86% under the national screening and treatment programme, versus by 41% under the historical base case. Annual discounted direct medical costs are expected to decrease from $178 million in 2018 to $81 million by 2030 under the historical base case, while annual direct medical costs are estimated to have peaked in 2019 at $312 million before declining to $55 million by 2030 under the national screening and treatment programme. Under the programme, annual disability-adjusted life years are expected to decline to 127 647 by 2030, leading to 883 333 cumulative disability-adjusted life years averted over 2018-2030. CONCLUSIONS: The national screening and treatment programme is highly cost-effective by the year 2021, cost-saving by 2029 and expected to save about $35 million in direct costs and $4705 million in indirect costs by 2030.

Three-dimensional echocardiographic assessment of left ventricular geometric changes following acute myocardial infarction.

Acute ST-segment elevation myocardial infarction (STEMI) is associated with left ventricular (LV) structural and functional consequences. We aimed to elucidate LV geometric changes following STEMI using three-dimensional (3D) echocardiography (3DE) and to assess their functional implications using two-dimensional (2D) speckle tracking echocardiography (STE). The study included 71 patients with STEMI who underwent baseline and 6-month follow-up 2D- and 3DE. Measured parameters included LV dimensions, biplane volumes, wall motion assessment, 2D LV global longitudinal strain (GLS), and 3D LV volumes, sphericity index and systolic dyssynchrony index. According to 3DE, LV geometric changes were classified as, adverse remodeling, reverse remodeling, and minimal LV volumetric changes. The occurrence of in-hospital and follow-up major adverse cardiovascular events (MACE) was assessed among the study population. The incidence of developing adverse remodeling was 25.4% while that of reverse remodeling was 36.6%. Adverse remodeling patients had significantly higher in-hospital MACE. Reverse remodeling was associated with significantly improved GLS, that was less evident in those with minimal LV geometric changes, and non-significant improvement for adverse remodeling group. LV baseline 2D GLS significantly correlated with follow-up 3D volumes among both reverse and adverse remodeling groups. Female gender and higher absolute GLS change upon follow-up were significantly associated with reverse remodeling. ROC-derived cutoff for adverse remodeling reallocated a substantial number of patients from the minimal change group to the adverse remodeling. Following acute STEMI, two-dimensional GLS was associated with and potentially predictive of changes in LV volumes as detected by three-dimensional echocardiography.

Assessment the effect of exposure to microplastics in Nile Tilapia (Oreochromis niloticus) early juvenile: I. blood biomarkers.

There is a scarcity of knowledge about the impacts of microplastics (MPs) on the early juvenile stage of freshwater fish. The current study aims to inspect the exposure and post-exposure recovery of microplastics (MPs) on accumulation and blood biomarkers of Nile Tilapia (Oreochromis niloticus) early juvenile. Four groups of fishes were used; the first group was the control group, the second group was exposed to (1 mg/L of MPs), the third group was exposed to (10 mg/L of MPs), and the fourth group was exposed to (100 mg/L of MPs) for 15 days and 15 days of recovery. The results showed that significantly higher numbers of microplastics were observed in microplastics-exposed groups compared to control group. Biochemical parameters (creatinine, uric acid, AST, ALT, ALP, glucose, cholesterol, total protein, albumin, globulin, and A/G ratio) showed significant increment after exposure to microplastics for 15 days compared to control group in dose dependent manner. The hematological indices (RBC's count, Hb, Ht, MCHC, Platelets, WBC's count, and monocytes) showed a significant decline after exposure to microplastics for 15 days compared to control group, while MCV and MCH showed a significant increase after exposure to microplastics for 15 days. After the recovery period, microplastics accumulations, hemato-biochemical alterations were still detected in microplastics exposed groups compared to the control group except for WBC's count and MCV which return to normal levels. MPs caused anemia and perturbations in hemato-biochemical parameters which may cause mortality of tilapia early juvenile and should be considered in a program for monitoring hazard materials in the ecosystem.