Different treatment strategies for haemophilia a with low inhibitor

To compare the cost-effectiveness of treatment options in three patients with haemophilia A and low titer inhibitors. We used a longitudinal before-and-after design that was conducted in two phases assessed retrospectively: Phase I was 6 months preceding the introduction of recombinant activated factor VII [rFVIIa] during which patients received on-demand usual care with plasma derived factor VIM regimes, phase two was 6 month treatment on rFVIIa. We determined the clinical response and the cost of treatment with NovoSeven in three patients with low titer inhibitors to factors VIM compared with other treatment regime previously used in these patients [Plasma derived factor VIM]. Total number of bleeding episodes, re-treatments and need of hospitalization were 21, 11 and 12 in phase 1 vs. 19, 0 and 0 in phase two respectively. Total cost of rFVIIa and plasma derived factor VIM treatment was USD 98600 vs. USD 77000. rFVIIa is clinically effective. It resulted in 100% reduction in the number of re-treatments, hospitalization and 21.9% reduction in the total cost compared to treatment with plasma derived factor VIM regime

Hospitalization causes due to iron overload in beta-Thalassemia in Gorgan, Iran

To evaluate causes of hospitalization [due to complications of iron overload and other causes] in beta-Thalassemic patients. This study was performed on 244 patients with major beta-Thalassemia admitted in Taleghani hospital of Gorgan between 2000 and 2007. Causes of hospitalization [due to complications of iron overload and other causes] were evaluated. Data were analyzed with SPSS software. The most common causes of hospitalization due to iron overload were diabetes mellitus [31.6%] and heart failure [16.4%]. The most common clinical findings were weakness and fatigue. We perceive increased frequency of diabetes mellitus in this center compared to other studies in Iran and abroad. Therefore glucose tolerance test and genotypic research for IVS II nt 745 are recommended in Thalassemic patient in this area

Frequency of beta thalassemia trait and carrier in Gorgan, Iran

To determine the frequency of beta-Thalassemia trait and carrier in Gorgan, Iran. In this analytic cross sectional study conducted from March 20, 2003 until March 20, 2004, two thousands six hundred prospective grooms and brides referred to the health center of Gorgan city were studied. Globular criteria included mean corpuscular hemoglobin [MCH] and mean corpuscular volume [MCV] were determined. Hemoglobin A2 [Hb A2] was measured by column chromatography method. The range of MCH was 13.8-35.5 pg.%15.9 of men and%27.6 of women had MCV<80fl. The frequency of beta-thalassemia trait was 9.8%. The range of HbA2 was 1.2-12% with the mean 3.06 +/- 1.5%. The frequency of beta-Thalassemia carrier [minor] was 21.4%.This high frequency of beta-Thalassemia trait and carrier in Gorgan constitutes a real health problem and it necessitates more diligent effort in health care specially education and counseling. Further studies should examine the value of counseling and the prevalence of beta-Thalassemia in the children of those married

[Comparison of the effect of early and late umbilical cord clamping on the Apgar score of the neonate]

After decades of discussion and dialogue, there is little agreement about suitable time for after birth umbilical cord clamping. By using the late cord clamping, neonate receives more placental transfusion that may affect the Apgar score. This study was designed to compare the effect of early and late cord clamping on the Apgar score of the neonate. This double blind, randomized, clinical trial carried out, in the year 2002 at Deziani Hospital of Gorgan, Iran. This study was approved by the local committee of medical ethics. Healthy full-term vaginally born neonates [n=64], were randomly allocated to early [30s] and late [3min] umbilical cord clamping group. During this period of time, the attendant held the neonate supine at the level of introitus. At the end of 1min and 5mins after birth. The Apgar score of the neonate, residual placental blood volume and estimated neonatal blood volume were determined. Data obtained by interview and observation, analyzed by SPSS software, Mann Whitney, t student and Chi-squared tests. There was a significant difference between early and late umbilical cord clamping groups [p<0.001], in the 1min and 5mins Apgar scores of the neonate. Placental residual blood volume in the late cord clamping group was 39.5% lower than the early cord clamping group [p<0.001]. Estimated neonatal blood volume in late cord clamping group was 7.1% higher than early cord clamping group [p<0.001]. Late cord clamping leads to a significant increase in the Apgar score of the neonate and the estimated neonatal blood volume. However, the placental residual blood volume significantly decreased. Further trials should delay cord clamping until cessation of cord pulse or alter the level that the newborn is kept