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BACKGROUND: Activated protein C resistance (APCR) due to factor V Leiden (FVL) mutation (R506Q) is a major risk factor in patients with venous thromboembolism (VTE). The present study investigated the clinical manifestations and the risk of venous thromboembolism regarding multiple clinical, laboratory, and demographic properties in FVL patients. MATERIAL AND METHODS: A retrospective cross-sectional analysis was conducted on a total of 288 FVL patients with VTE according to APCR. In addition, 288 VET control samples, without FVL mutation, were also randomly selected. Demographic information, clinical manifestations, family and treatment history were recorded, and specific tests including t-test, chi-square and uni- and multi-variable regression tests applied. RESULTS: APCR was found to be 2.3 times significantly more likely in men (OR: 2.1, p < 0.05) than women. The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in APCR patients was 4.5 and 3.2 times more than the control group, respectively (p < 0.05). However, APCR could not be an independent risk factor for arterial thrombosis (AT) and pregnancy complications. Moreover, patients were evaluated for thrombophilia panel tests and showed significantly lower protein C and S than the control group and patients without DVT (p < 0.0001). CONCLUSION: FVL mutation and APCR abnormality are noticeable risk factors for VTE. Screening strategies for FVL mutation in patients undergoing surgery, oral contraceptive medication, and pregnancy cannot be recommended, but a phenotypic test for activated protein C resistance should be endorsed in patients with VTE.
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OBJECTIVE: Opioid abuse is widespread throughout the world. Aspiration pneumonia is a serious problem following opioid overdose and poisoning. This study aimed to evaluate the safety and effectiveness of antimicrobial management of opioid-overdose induced aspiration pneumonia in a referral poisoning management university hospital in Iran. METHODS: In an observational cross-sectional study (September-March 2019), opioid poisoned patients diagnosed with aspiration pneumonia within a maximum of 48 h of their overdose were evaluated regarding several variables, including the level of consciousness on admission, drug regimen used for the treatment of aspiration pneumonia, and its appropriateness, and the correctness of the used antibiotics dose and the therapeutic outcome. FINDINGS: During the study, 53 eligible patients were identified and included in the study. The most frequently abused opioids were methadone (60.4%) and opium (17%). "Ceftriaxone + Clindamycin" (54.7%) and "Meropenem + Vancomycin" (9.5%) were the most frequently administered regimens. Regarding treatment outcome, most cases (n = 36, 67.9%) were discharged with a stable and satisfying medical status, while 3.8% of the cases (n = 2) died. CONCLUSION: The use of antibiotics in the treatment of aspiration pneumonia in hospitalized patients with opioid overdose in our referral university hospital is associated with notable antibiotic regimen choice issues. The implementation of strategies for improving the pattern of antibiotic prescribing for these patients is necessary.
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BACKGROUND: Cetuximab is a monoclonal antibody which acts against the epidermal growth-factor receptor. Randomized controlled trials show that the addition of cetuximab to folinic acid, 5-flourouracil, irinotecan (FOLFIRI), folinic acid, 5-flourouracil, oxaliplatin (FOLFOX) and capecitabin + oxaliplatin (CAPOX) regimens, as the first-line treatment for metastatic colorectal cancer (CRC), increases the overall survival (OS) and progression-free survival (PFS) compared to FOLFIRI, FOLFOX and CAPOX regimens alone. The aim of this study was to analyze the cost-effectiveness of different treatment programs for managing metastatic CRC with and without cetuximab in the first-line treatment of unresectable metastatic CRC in Iran. METHODS: A systematic search of the literature was performed in PubMed, Centre for Reviews and Dissemination Databases and Cochrane Library to assess the effectiveness of the drug in the context of PFS, OS and the adverse events. The incremental cost-effectiveness ratio of each treatment program was calculated. An extensive sensitivity analysis was conducted on the results regarding the effectiveness. RESULTS: The addition of cetuximab to FOLFIRI, FOLFOX and CAPOX programs increased PFS by 0.1, 0.042 and 0.042 years, respectively. Similarly, the addition of cetuximab to FOLFIRI, FOLFOX and CAPOX increased OS by 0.325, 0.442 and 0.442 years and also cost $212825, $202484 and $204198 individually. Whereas, based on the World Health Organisation (WHO) suggested threshold for cost-effectiveness analysis, even FOLFOX + cetuximab was very higher than the threshold in Iran (37.4 times higher). CONCLUSIONS: The FOLFOX regimen + cetuximab provides lower costs per additional life years gained (more cost-effective) compared with its alternatives in the treatment of patients with unresectable metastatic CRC. However, according to the WHO indicator, none of the cetuximab regimens could be considered as cost effective for the Iranian health care market.