Pengaruh Ekstrak Paederia foetida pada Kadar Kolesterol Total Tikus Model Hiperlipidemia yang Diinduksi Deksametason

Hiperlipidemia merupakan istilah yang mengacu pada kelainan yang menyebabkan peningkatan profil lipid dalam tubuh manusia. Menurut WHO, secara global, sepertiga penyakit jantung iskemik dikaitkan dengan kadar kolesterol yang tinggi. Peningkatan kadar kolesterol diperkirakan menyebabkan 94,9 juta disability adjusted life year (DALYs) dan 4,32 juta kematian. Penelitian ini bertujuan untuk mengevaluasi pengaruh ekstrak etanol Paederia foetida (EEPF) pada kadar kolesterol total tikus model hiperlipidemia yang diinduksi deksametason. Penelitian Penelitian eksperimen in vivo ini dilakukan dengan menggunakan desain penelitian post-test only complete randomized design (CRD). Proses penelitian dilaksanakan di Departemen Biokimia, Fakultas Kedokteran, Universitas Airlangga, Surabaya, Indonesia, dari bulan Juni 2021 hingga November 2021. Pembuatan EEPF dilakukan dengan metode maserasi pada pelarut etanol 96%. Hewan coba yang digunakan adalah tikus galur Wistar albino jantan berjumlah 30 ekor, sehat, dan berat badan 150-200 gram. Penelitian dilaksanakan dengan membagi rata hewan coba secara acak menjadi kelompok kontrol normal, kontrol patogen, kelompok simvastatin, kelompok EEPF 250 mg/kg, dan kelompok EEPF 500 mg/kg. Sampel darah diambil dari vena pada bagian ekor dan kadar kolesterol total diukur dengan metode point of care testing (POCT). Analisis data dilakukan dengan One-way ANOVA dilanjutkan dengan uji post hoc Dunnett. Hasil penelitian menunjukkan, pemberian deksametason (10 mg/kg) selama 14 hari menyebabkan peningkatan kadar kolesterol total yang signifikan, sedangkan pada kelompok perlakuan simvastatin, EEPF 250 mg/kg, dan EEPF 500 mg/kg terjadi penurunan signifikan pada kadar kolesterol total jika dibandingkan dengan kelompok kontrol patogenik (P<0,001, P<0,05, P<0,05). Pemberian ekstrak etanol Paederia foetida dapat menurunkan kadar kolesterol total pada tikus model hiperlipidemia yang diinduksi deksametason.

COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran

COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.

The Global Burden of Sexually Transmitted Infections Estimated from 1990 to 2019

Background:To explore the burden of sexually transmitted infections at national, regional, and global levels from the 2019 Global Burden of Disease Study database. Methods: The number of cases and age-standardized rate of prevalence, incidence, and disability-adjusted life years were used for a descriptive study of sexually transmitted infections burden from 1990 to 2019, and secular trends were assessed by counting the estimated annual percentage change. Finding:The global prevalence of sexually transmitted infections in 2019 was 128.82 million. There were 58.15% new cases than in 1990. The disability-adjusted life year burden of sexually transmitted infections was lower among males than females and peaks among under 5 and 15- to 44-year-olds. In 2019, the global disability-adjusted life year loss was mostly attributed to years of life lost (88.23%), the higher the social development index developed, the more the number of years lived with disability contributed. In 21 regions, the age-standardized rates of disability-adjusted life year (per 100, 000 population) showed that the Caribbean remained on top. At a national level, a decreasing trend of the estimated annual percentage change of disability-adjusted life year rate had been observed. Syphilis was proved as a leading cause of heavy disease burden, which carried almost 85.9% of it. The age-standardized rates of disability-adjusted life year were in positive correlation with the human development index in 2019 and had a negative correlation with the estimated annual percentage change in 1990. Conclusion: A declining trend of sexually transmitted infections was observed globally; prevention of syphilis remained a crucial strategy in the course of reducing sexually transmitted infections burden. The findings from this research can help to establish appropriate health policy and reduce the disease burden further.

Pharmacoeconomic Study on the Application of Magnetic Resonance Imaging with Gadoxetic Acid in Addition to Contrast-Enhanced Computed Tomography in Diagnosis of Hepatocellular Carcinoma

Objective: to evaluate pharmacoeconomic advantages of the application of magnetic resonance imaging (MRI) with hepatobiliary-specific contrast agent – gadoxetic acid in addition to contrast-enhanced computed tomography (CT) in the diagnosis of hepatocellular carcinoma (HCC).Material and methods. We performed the modeling and obtained the results of the pharmacoeconomic study: effectiveness analysis, cost analysis, and cost-effectiveness analysis. The cost analysis included only direct medical costs (the cost of contrast-enhanced CT, gadolinium-based contrast agent (GBCA) for MRI, and therapy per a patient with verified HCC diagnosis after diagnostic procedures). The financing was performed from the Compulsary Health Insurance Fund. The calculations were made per 1 patient.Results. The effectiveness analysis showed that the diagnostic scheme CT + MRI with gadoxetic acid was the most effective complex for the diagnosis of HCC because its application provided 50% of patients with 5-year overall survival (4.8 years), which was significantly higher than in patients who were diagnosed HCC with CT + MRI with extracellular GBCA (2.3 years) or CT (3.7 years). The cost-effectiveness analysis showed that the diagnostic scheme with gadoxetic acid was dominant because each disability-adjusted life year required fewer costs (14 862 rubles) in comparison with CT + MRI with extracellular GBCA (25 293 rubles) or CT (46 540 rubles). According to the results of the incremental cost-effectiveness ratio analysis, the application of the diagnostic complex with gadoxetic acid was characterized by the lowest rate of additional costs per 1 disability-adjusted life year.Conclusion. The pharmacoeconomic study showed that the application of MRI with a hepatospecific contrasting agent – gadoxetic acid in addition to contrast-enhanced CT was an effective and economically beneficial method of early HCC diagnosis.

Global red and processed meat trade and non-communicable diseases

IntroductionRapid increases in the trade of global red and processed meat impede international efforts toward sustainable diets by increasing meat consumption. However, little research has examined cross-country variations in diet-related non-communicable diseases (NCDs) because of meat trade. We aimed to examine the impact of red and processed meat trade on diet-related NCDs and to identify which countries are particularly vulnerable to diet-related NCDs due to red and processed meat trade.MethodsBy selecting 14 red meat and six processed meat items, we investigated bilateral meat trade flows across 154 countries. Then, we integrated health data and information on red and processed meat trade to quantify the country-specific burden of diet-related NCDs attributable to the meat trade using a comparative risk assessment framework.ResultsResults show that global increases in red and processed meat trade contributed to the abrupt increase of diet-related NCDs, and the attributable burden of diet-related NCDs had large geographical variations among countries. We also identified responsible exporting countries that increase diet-related NCD risks in importing countries. Over the period from 1993 to 2018, island countries in the Caribbean and Oceania were particularly vulnerable to diet-related NCD incidents and mortality due to large meat imports. In addition, countries in Northern and Eastern Europe have exceedingly increased attributable death and disability-adjusted life year rates via meat imports.ConclusionOur findings suggest that both exporters and importers must urgently undertake cross-sectoral actions to reduce the meat trade’s health impacts. To prevent unintended health consequences due to red and processed meat trade, future interventions need to integrate health policies with agricultural and trade policies by cooperating with both responsible exporting and importing countries.

Worldwide Trends in Prevalence, Mortality, and Disability-Adjusted Life Years for Hypertensive Heart Disease From 1990 to 2017

Hypertensive heart disease (HHD) is a major cause of global morbidity and mortality. Understanding its current burden among various countries and populations is crucial for formulating effective strategies for preventing and managing HHD. This study aimed to use the estimates from the Global Burden of Disease Study 2017 to describe the prevalence, mortality, and disability-adjusted life years for HHD for 195 countries and territories from 1990 to 2017. Worldwide, the age-standardized prevalence rate of HHD in 2017 was 217.9 (95% uncertainty interval [UI], 184.1–254.1) per 100 000 people, an increase of 7.4% (95% UI, 5.0–9.7) from 1990. The global age-standardized mortality and disability-adjusted life year rates of HHD were 12.3 (95% UI, 9.0–13.2) and 209.4 (95% UI, 160.5–226.3) per 100 000 people, a decrease of −19.3% (95% UI, −29.7 to −8.1) and −24.0% (95% UI, −31.0 to −13.7) from 1990, respectively. The global age-standardized prevalence rate of HHD was higher in females and increased with age. Between 1990 and 2017, Bolivia (51.3% [95% UI, 29.6–84.5]) and Maldives (32.3% [95% UI, 22.9–43.8]) showed the greatest increases in age-standardized prevalence rates. Generally, a negative association was found between the age-standardized disability-adjusted life year rates and Sociodemographic index at the regional and national levels. Our results suggest that HHD is a major public health challenge worldwide with an increasing prevalence rate over the past decades. Efforts to improve public awareness and management of high blood pressure and HHD, especially for vulnerable populations, were necessary.

Reassessing the Cost-Effectiveness of High-Provitamin A Bananas to Reduce Vitamin A Deficiency in Uganda

There are two high-provitamin A (pVA) banana-based interventions potentially available in Uganda—biofortified genetically modified (GM) banana and fast-tracked banana landraces from outside Uganda that are naturally high in provitamin A (nHpVA). Based on the newest country statistics and using adoption scenarios obtained through focus group discussions and expert interviews, we assess obstacles and opportunities for adoption as well as cost-effectiveness of these interventions. In two alternative scenarios for the GM banana (M9 matooke), we assume 40% and 64% adoption rates, which would result in US$29,374,151 and US$63,259,415 in income saved, respectively. As an alternative, for the symmetrical scenarios, we calculate that if the nHpVA banana (Apantu plantain, native of Ghana) were to be adopted, US$46,100,148 and US$76,364,988 in income would be saved. Taking into account the full cost of R&amp;D, we estimate that the M9 matooke could save one disability-adjusted life year (DALY) at a cost of US$67.37 at best and US$145.09 at worst. We estimate that the Apantu plantain could save one DALY at a cost of US$50.54 at best and US$83.72 at worst. Our DALY analysis estimates that all assessed HpVA banana interventions are extremely cost-effective in all scenarios, following both the World Bank's and the WHO criteria. Nevertheless, successful interventions would require extensive promotion campaigns and shifts in agricultural value chains.

The Impact of Energy Consumption on the Three Pillars of Sustainable Development

The paper analyzes the impact of energy consumption on the three pillars of sustainable development in 74 countries. The main methodological challenge in this research is the choice of a single integral indicator for assessing the social component of sustainable development. Disability-adjusted life year (DALY), ecological footprint, and GDP (Gross domestic product) are used to characterize the social, ecological, and economical pillars. The concept of physics, namely the concept of density (specific gravity), is used. It characterizes the ratio of the mass of a substance to its volume, i.e., reflects the saturation of a certain volume with this substance. Thus, to assess the relationship between energy consumption and the three foundations of sustainable development, it is proposed to determine the energy density of the indicators DALY, the ecological footprint, and GDP. The reaction to changes in energy consumption is described by the elasticity of energy density functions, calculated for each of the abovementioned indicators. The state of the social pillar is mostly dependent on energy consumption. As for the changes in the ecological pillar, a 1% reduction in energy consumption per capita gives only a 0.6% ecological footprint reduction, which indicates a low efficiency of reducing energy consumption policy and its danger for the social pillar. The innovative aspect of the research is to apply a cross-disciplinary approach and a calculative technique to identify the impact that each of the pillars of sustainable development imposes on energy policy design. The policy of renewable energy expansion is preferable for all sustainable development pillars.

Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals

Hospitals in Kenya continue to use the Febrile Antigen Brucella Agglutination Test (FBAT) to diagnose brucellosis, despite reports showing its inadequacy. This study generated hospital-based evidence on the performance and cost-effectiveness of the FBAT, compared to the Rose Bengal Test (RBT).Twelve hospitals in western Kenya stored patient serum samples that were tested for brucellosis using the FBAT, and these were later re-tested using the RBT. Data on the running time and cost of the FBAT, and the treatment prescribed for brucellosis, were collected. The cost-effectiveness of the two tests, defined as the cost in US Dollars ($) per Disability Adjusted Life Year (DALY) averted, was determined, and a basic sensitivity analysis was run to identify the most influential parameters. Over a 6-month period, 180 patient serum samples that were tested with FBAT at the hospitals were later re-tested with RBT at the field laboratory. Of these 24 (13.3%) and 3 (1.7%) tested positive with FBAT and RBT, respectively. The agreement between the FBAT and RBT was slight (Kappa = 0.12). Treatment prescribed following FBAT positivity varied between hospitals, and only one hospital prescribed a standardized therapy regimen. The mean $/DALY averted when using the FBAT and RBT were $2,065 (95% CI $481-$6,736) and $304 (95% CI $126-$604), respectively. Brucellosis prevalence was the most influential parameter in the cost-effectiveness of both tests. Extrapolation to the national level suggested that an estimated $338,891 (95% CI $47,000-$1,149,000) per year is currently spent unnecessarily treating those falsely testing positive by FBAT. These findings highlight the potential for misdiagnosis using the FBAT. Furthermore, the RBT is cost-effective, and could be considered as the mainstay screening test for human brucellosis in this setting. Lastly, the treatment regimens must be harmonized to ensure the appropriate use of antibiotics for treatment.