Medicine
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Comparative Study
A comparison between on-demand usage of rFVIIa vs prophylaxis use of emicizumab in high titer inhibitory hemophilia A patients in Iran: A cost-utility analysis.
Hemophilia A (HA) is an inherited X-linked bleeding disease with costly treatment, especially for high titer inhibitory patients. Emicizumab, a new humanized bispecific antibody, has been approved for use to prevent or reduce the frequency of bleeding episodes in HA patients with inhibitors. This study evaluated the cost-utility of emicizumab prophylaxis (EP) in comparison with recombinant factor VII activated on-demand treatment in HA patients with inhibitors. ⋯ EP was found to be a dominant and cost-effective choice for Iranian HA patients with factor VIII inhibitors with ABR 18 and above with considerable cost saving.
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Observational Study
Impact of drug formulation on outcomes of pharmaceutical poisoning in children aged 7 years or younger: A retrospective observational study in South Korea.
Pharmaceutical poisoning in children is almost unintentional and there are various types of drug out of curiosity. Understanding the attractive features and formulation of drugs related to poisoning in younger children may be helpful in treatment and prevention of poisoning. To investigate the impact of drug formulation on outcomes of pharmaceutical poisoning in young children. ⋯ The median size of the TACs was less than 1.0 cm. Young children who visited the ED ingested TACs more frequently than syrups, particularly small, round-shaped, or chromatic drugs, leading to a higher hospitalization rate. Our findings can contribute to prevention strategies and safety education on childhood drug poisoning.
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Case Reports Observational Study
Efficacy of intravitreal dexamethasone implant in patients with Vogt-Koyanagi-Harada Disease and bilateral panuveitis: Two case reports.
Vogt-Koyanagi-Harada (VKH) disease is a multisystemic disorder characterized by intraocular inflammation associated with serous retinal detachment, optic disc edema, uveitis, and vitritis, and is often associated with neurologic and cutaneous manifestations. Diagnosis can be assisted by fluorescein angiography and optical coherence tomography that can help evaluate changes in the retina. Therapy relies mainly on the use of corticosteroids, administrated through oral or intravenous high-dose pulses, and immunosuppressants. The purpose of our study was to assess the outcome of VKH disease with bilateral panuveitis treated with dexamethasone intravitreal implant. ⋯ VKH disease is a multisystemic disorder; intravenous pulse steroid therapy and oral prednisolone can control systemic inflammation. In addition to systemic prednisolone treatment of VKH disease in the acute phase, dexamethasone implants can enhance short-term and long-term control of intraocular anti-inflammation.
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Observational Study
Outcomes of patients with Down syndrome and acute leukemia: A retrospective observational study.
Children with Down syndrome (DS) have a higher risk of developing acute leukemia than do those without DS. There are few studies in the literature about outcome, survival, and difficulties of treating patients with DS and acute leukemia in a developing country. This study aimed to analyze the outcome, response to treatment, survival, treatment complications, and causes of death in patients with DS and acute leukemia compared with those in patients with acute leukemia without DS diagnosed in the same period of time. ⋯ The relapse rate was higher in patients with DS-ALL but not significantly higher than that in patients without DS (P = .13). In contrast, the overall survival rate was better for patients with DS-AML than for those with acute myeloid leukemia without DS (57.1% vs 45.1%, P = .47). Because of the particularities of the host, we suggest that DS-ALL and DS-AML should be considered as independent diseases and treated according to specific protocols with therapy optimization per the minimal residual disease.
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Ankle fractures are the most common intra-articular fractures. Osteoporosis is a common and frequent disease among the elderly with a poor prognosis and high risk of fractured ankles. However, the relationship between vitamin B6 and the incidence of fractured ankles in patients with osteoporosis is unclear. ⋯ In terms of multivariate logistic regression level, vitamin B6 (OR = 15.384, 95% CI:5.195-45.556, P < .001) was significantly associated with fractured ankle. In addition, expression level of vitamin B6 [hazard ratio (HR) = 11.684, 95% CI: 6.419-21.267, P < .001] was significantly associated with Maintenance time from recovery to recurrence (MRTT) of patients with osteoporosis. Enhanced vitamin B6 is significantly correlated with the poor prognosis of patients with osteoporosis and the increasing incidence of fractured ankles.