Cost-effectiveness of a medication event monitoring system for tuberculosis management in Morocco.

BACKGROUND: Digital health technologies have been used to enhance adherence to TB medication, but the cost-effectiveness remains unclear. METHODS: We used the real data from the study conducted from April 2014 to December 2020 in Morocco using a smart pillbox with a web-based medication monitoring system, called Medication Event Monitoring Systems (MEMS). Cost-effectiveness was evaluated using a decision analysis model including Markov model for Multi-drug resistant (MDR) TB from the health system perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability adjusted life-year (DALY) averted. Two-way sensitive analysis was done for the treatment success rate between MEMS and standard of care. RESULTS: The average total per-patient health system costs for treating a new TB patient under MEMS versus standard of care were $398.70 and $155.70, respectively. The MEMS strategy would reduce the number of drug-susceptible TB cases by 0.17 and MDR-TB cases by 0.01 per patient over five years. The ICER of MEMS was $434/DALY averted relative to standard of care, and was most susceptible to the TB treatment success rate of both strategies followed by the managing cost of MEMS. CONCLUSION: MEMS is considered cost-effective for managing infectious active TB in Morocco.

Effects of defibrotide, a novel oligodeoxyribonucleotide, on ischaemia and reperfusion injury of the rat liver.

1. The purpose of this study was to investigate the protective effects of defibrotide, a single-stranded polydeoxyribonucleotide, on ischaemia-reperfusion injury to the liver using a rat model. 2. Ischaemia of the left and median lobes was created by total inflow occlusion for 30 min followed by 60 min of reperfusion. Hepatic injury was assessed by the release of liver enzymes (alanine transferase, ALT and lactic dehydrogenase, LDH). Hepatic oxidant stress was measured by superoxide production, lipid peroxidation and nitrite/nitrate formation. Leukocyte-endothelium interaction and Kupffer cell mobilization were quantified by measuring hepatic myeloperoxidase (MPO), polymorphonuclear leukocyte adherence to superior mesenteric artery (SMA) and immunostaining of Kupffer cell. 3. Defibrotide treatment resulted in a significant inhibition of postreperfusion superoxide generation, lipid peroxidation, serum ALT activity, serum LDH activity, MPO activity, serum nitrite/nitrate level, leukocyte adherence to SMA, and Kupffer cell mobilization, indicating a significant attenuation of hepatic dysfunction. 4. A significant correlation existed between liver ischaemia/reperfusion and hepatic injury, suggesting that liver ischaemia/reperfusion injury is mediated predominantly by generation of oxygen free radicals and mobilization of Kupffer cells. 5. We conclude that defibrotide significantly protects the liver against liver ischaemia/reperfusion injury by interfering with Kupffer cell mobilization and formation of oxygen free radicals. This study provides strong evidence that defibrotide has important beneficial effects on acute inflammatory tissue injury such as that occurring in the reperfusion of the ischaemic liver.

How Many Diabetes Patients Know the Name of Hypoglycemic Agents They Are Taking?

BACKGROUND: Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control. METHODS: A cross-sectional questionnaire survey was done from March to May 2004, targeting in-patients and out-patients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals. RESULTS: 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P<0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P<0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to toke medicine (P<0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P<0.0001) were the independent related factors after adjustment. CONCLUSION: The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.

An Analysis of Attitudes on Euthanasia between Residents and Judicial Apprentices

BACKGROUND: Recently, the legal and ethical issues relative to euthanasia are becoming controversial in Korea. This study was designed to verify the differences of the attitudes on euthanasia between judicial apprentices and residents. METHODS: The questionnaire was conducted on the 35th-group of the judicial apprentices on March 24, 2004, and on the residents from April 2 to May 22, 2004. The respondents were 636 in total consisting of 460 judicial apprentices and 176 residents. RESULTS: Of the total 636 subjects, 373 (81.1%) of the judicial apprentices and 149 (84.7%) of residents agreed that allowing euthanasia is moral, without any significant difference (P>0.05). The number of residents was greater (59 people, 33.5%) than that of judicial apprentices (112 people, 24.4%) who agreed with active euthanasia (P0.05). But, among these supporters, the respondents who agreed on active euthanasia were significantly different in number between judicial apprentices (n=93, 23.4%) and residents (n=54, 33.8%) (P<0.05). CONCLUSION: This study did not find any significant differences between the two groups in the necessity of the law for euthanasia, but the rate of agreement on active euthanasia was higher in residents group than in judicial apprentices group.