The human papillomavirus vaccination: a review of the cost-effectiveness studies.

BACKGROUND: The Human Papillomavirus (HPV) is one of the most common sexually transmitted viruses, its infection with certain subtypes is the primary cause of cervical cancer. Several countries conducted specific cost-effectiveness evaluations toward HPV vaccination. The constant growth of healthcare demand, in an economic context characterized by limited resources, requires that the decision-making process be based on the comparison of alternative choices. This study offers an overview of the published cost-effectiveness studies about HPV vaccination. BIBLIOGRAPHIC RETRIEVAL METHOD: The research was performed on the scientific databases MEDLINE and SCOPUS in order to find out journal articles focused on cost-effectiveness of the HPV vaccination. The rational for any exclusion criteria of data in the search is mainly due to lack of relevance to cost-effectiveness information. RESULTS: The literature results were presented according to different groups of countries worldwide. A total of 24 articles were finally retrieved. In spite of the different models and assumptions, most studies showed the cost-effectiveness of vaccination; only two studies considered the vaccination as not cost effective. CONCLUSIONS: HPV vaccination may determine a cost reduction for country-specific National Health Systems. However, the cost-effectiveness of universal HPV vaccination still remains an open debate. It is important that economic analysis of universal HPV vaccination adopts large perspectives than is the case with the existing literature, focusing on the critical issues that still exist in many areas. Reducing cost, increasing duration of efficacy, and integrating vaccines into existing screening and treatment procedures in a cost-effective manner are of crucial importance even as they are a major challenge.

A pilot study of the effect of pantothenic acid in the treatment of post-operative ileus: results from an orthopedic surgical department.

OBJECTIVES: Post-operative ileus can also occur in other types of surgery not strictly related to abdomen. The objective of this study was to investigate the efficacy of pantothenic acid administration to stimulate intestinal peristalsis in case of post-operative ileus and estimate the most effective dose. This vitamin can be used for the treatment of chronic atonic intestine or for chronic constipation, but therapeutic indications are not precise in these conditions. PATIENTS AND METHODS: This pilot study has used patients divided in groups treated in post-operative period with physiological solution for patients in control group (Placebo) and Dexpantenolo, which is a derivative in alcohol of pantothenic acid, for all the actively treated patients. The treatments were administered intravenously during the second and third post-operative day, according to the treatment schedule. RESULTS: 60 patients were recruited and they were allocated to five treatment groups or one control group. For males, the median time of the first bowel evacuation was 90 hours while for females the median time was 84 hours (p=0.891). For patients who received a spinal anesthetic, the median time was 72 hours, while for those who received a peridural anesthetic the median time was 96 hours (p=0.571). Between six treatment groups, instead, there is a significant difference between the median times from the operation to the first bowel evacuation (p<0.001). Linear regression model obtained using as outcome evacuation hours after surgery show that only variable which significantly affects time between operation and the first bowel evacuation is treatment dose (Beta = -0.868, p<0.001). DISCUSSION: This study would seem to indicate that pantothenic acid is effective for treatment of post-operative intestinal ileus; there is a dose response relationship between pantothenic acid and the decreasing time from surgical operation to first bowel evacuation. However, this study is preliminary; further studies are necessary, preferably randomized and with a larger number of patients.

Pilot study of the effect of vitamin B6 on the motility of guinea pigs ileum: possible implications for human intestinal motility.

OBJECTIVES: To evaluate the effect of vitamin B6 and neostigmine on the intestinal motility of guinea pigs, to obtain beneficial effects on human health. MATERIALS AND METHODS: Segments of the ileum of guinea pigs have been removed and mounted in an organ bath in order to record their motility when treated with vitamin B6, atropine and neostigmine. This motility has been compared with the contraction produced by acetylcholine. These substances were injected into the cuvette of the apparatus both singularly and in combination. RESULTS: The isolated segments of the ileum of guinea pigs exposed to vitamin B6 (5.91 x 10(-8) M) have asthenic contraction of 59.38 + 11.28 (mean + SD) compared with the peak observed for acetylcholine. When atropine (2.76 x 10(-7) M) was administered during the contraction produced by the vitamin B6, the contraction was blocked. Neostigmine (1.50 x 10(-5) M) on its own produced asthenic contraction 59.16 + 10.11 (mean + SD) compared with the peak observed for acetylcholine. Neostigmine administered after vitamin B6 (5.91 x 10(-8) and 1.48 x 10(-7) M) produces a mean contraction of 104.50 + 8.77 and 108.8 + 12.65 (mean + SD) compared with acetylcholine. CONCLUSIONS: Data reported show that vitamin B6 has an effect on the motility of the ileum of guinea pigs. The contraction produced by the combination of vitamin B6 and neostigmine is greater and more prolonged than that produced by neostigmine alone. This association could improve the efficacy of neostigmine to resolve intestinal asthenia as quickly as possible to obtain beneficial effects on human health.

Plasma and platelet ascorbate pools and lipid peroxidation in insulin-dependent diabetes mellitus.

BACKGROUND: As diabetes mellitus represents a situation in which production of peroxides is increased, the aim of this study was to investigate the relationship between plasma and platelet levels of ascorbic acid (AA)/dehydroascorbic acid (DHA) and those of malonyldialdehyde (MDA), an indirect marker of lipoperoxides, both assayed using high-performance liquid chromatography (HPLC), in 59 patients with insulin-dependent diabetes mellitus (IDDM) compared with 51 healthy control subjects matched for sex, age, smoking habits, as well as for dietary intake of energy, alcohol and vitamin C. RESULTS: Mean plasma and platelet MDA were significantly higher in the patients affected with IDDM than in control subjects. Moreover, the diabetic group was characterized by a huge decrease in plasma AA [8.45 +/- 5.5 mumol L-1 (SD) vs. 33.4 +/- 7.6 mumol L-1, P = 0.0001], mirrored by a significant increase in plasma DHA (11.9 +/- 3.9 mumol L-1 vs. 3.9 +/- 2.5 mumol L-1, P = 0.0001). No detectable DHA was observed in the platelets from both diabetic and control subjects, whereas AA was significantly increased in platelets from diabetic patients compared with control subjects (42.6 +/- 7.4 vs. 34.8 +/- 5.1 nmol 10(-9) platelets, P = 0.0001). Platelet AA in the diabetic group was significantly inversely correlated with glycated haemoglobin (r = -0.34; P = 0.04) and directly with plasma AA (r = 0.39; P = 0.02), the sum of plasma AA + DHA (r = 0.44; P = 0.009) and with platelet MDA (r = 0.38; P = 0.02). CONCLUSION: (a) The ratio plasma AA/DHA is significantly lowered in IDDM in association with an increase in MDA levels; (b) only AA is detected in platelets, being augmented in the diabetic group; (c) plasma ascorbate depletion does not reflect platelet levels of AA; and, finally, (d) metabolic control, as well as intracellular lipoperoxides, modulates platelet AA in IDDM.

Renal excretion of ascorbic acid in insulin dependent diabetes mellitus.

Serum ascorbic acid (AA) is reduced in diabetic patients. Aim of this study was 1) to verify whether such a decrease might be due to an altered urinary excretion of AA, and 2) whether this latter was modified in presence of early diabetic nephropathy with microalbuminuria (albumin excretion rate [AER] > 20 micrograms/min) in a group of 21 patients affected by insulin-dependent (type 1) diabetes mellitus (IDDM) as compared with 13 healthy controls matched for sex, age, dietary AA intake, and creatinine clearance per 1.73 m2 (CCl). Mean serum AA (+/- SD) was lower in diabetics (40.3 +/- 14 microM/l) than in controls (85.1 +/- 23.5 microM/l; p = 0.0001) and there was no difference between serum AA of patients with or without microalbuminuria. Urinary excretion of AA to creatinine x 100 (UAA/Cr) was higher in micro- (n = 6; 4.6 +/- 1.7) as compared to normoalbuminurics (n = 15; 1.6 +/- 0.9) or controls (1.5 +/- 1.2; p = 0.0001). For values exceeding renal threshold of tubular AA reabsorption (39 microM) the regression line of serum AA to UAA/Cr was significantly (p = 0.001) steeper in diabetics than in controls, suggesting an impaired tubular reabsorption of filtered AA in IDDM. The ratio of AA clearance to CCl was moreover related to AER (r = 0.48; p = 0.03) and to blood glucose (r = 0.51; p = 0.01), being unrelated to uric acid clearance, glycosuria and to urinary excretion of both alanine aminopeptidase and N-acetyl-beta-glucosaminidase.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma retinol and alpha-tocopherol concentrations in insulin-dependent diabetes mellitus: their relationship to microvascular complications.

Plasma alpha-tocopherol and retinol, both assayed by an HPLC method, have been evaluated in a group of 60 patients affected by insulin-dependent (type 1) diabetes mellitus, stratified according to the presence of retinopathy and nephropathy diagnosed by an urinary albumin excretion rate ranging between 20 and 200 micrograms/min (microalbuminaria) or > 200 micrograms/min (macroalbuminuria), all of whom were compared with 26 healthy controls strictly matched for age and sex. Plasma lipids and age were positively correlated with plasma retinol and alpha-tocopherol in both diabetic and control subjects. Either plasma retinol or its ratio to cholesterol were significantly and independently reduced in the younger subset of diabetics, as compared to controls, independently from other confounding variables, while plasma alpha-tocopherol was unchanged in diabetic subjects and in healthy controls. Retinopathy was not associated with altered levels of both plasma alpha-tocopherol or retinol. The presence of increased urinary albumin excretion was associated with higher plasma levels of alpha-tocopherol and, only for macroalbuminuria, of retinol. However, after processing the data by a multivariate model, nephropathy was characterized by an increase only in plasma alpha-tocopherol. In conclusion, according to our findings, plasma retinol is significantly decreased in younger insulin-dependent diabetic patients while alpha-tocopherol is significantly altered in diabetic patients with nephropathy.

Vitamin C and nutritional status of institutionalized and noninstitutionalized elderly women in Rome.

A cross-sectional study on 64 institutionalized and 65 noninstitutionalized elderly women has been undertaken. The age range was 60 through 90 years. Vitamin C status was assessed by serum ascorbic acid measurement and the nutritional status was evaluated by a three-day dietary record and main anthropometric measurements. Mean concentration of ascorbic acid was 1.03 mg/dl in the noninstitutionalized and 0.67 mg/dl in the institutionalized group (p less than 0.001). A serum ascorbic acid level less than 0.2 mg/dl was found in one (1.5%) and seven (10.9%) subjects respectively (p less than 0.03). Mean intake of vitamin C was 104.1 mg/d in the former and 87.3 mg/d in the latter group (p = NS), being less than 45 mg/d in 16 living at home and 11 institutionalized women. Serum ascorbic acid level did not correlate significantly to dietary nutrient intake but correlated to activity of daily living level (r = 0.29), vitamin C intake (r = 0.23), ideal body weight (r = -0.15), relative body weight (r = 0.15) and body mass index (r = 0.14). Suggestions are made concerning a higher intake of vitamin C and a more careful catering to improve the health status of the elderly people living in large institutions. The authors also suggest to include the serum ascorbic level determination in the assessment of the general health status of the elderly.

[Serum values of vitamins A, E, C and carotenoids in healthy adult subjects and those with breast neoplasia]. / Valori sierici delle vitamine A, E, C e dei carotenoidi in soggetti adulti sani ed affetti da neoplasie mammarie.

Serum values of retinol, carotenoids, tocopherol and ascorbic acid were assayed in healthy adult females (Group A: 20 cases) and in subjects with fibrocistic mastopathy (Group B: 20 cases), benign breast neoplasms, as fibroadenomas and intraductal papillomas (Group C: 18 cases), and breast carcinoma in situ (Group D: 36 cases). Retinol and carotenoids were evaluated by spectrophotometry using trifluoroacetic acid. Tocopherol was determined by a colorimetric method involving the reduction of Fe to Fe++ by tocopherol with the formation of a red complex of the Fe++ with alpha, alpha'-dipirydyl. Ascorbic acid was estimated by a colorimetric method after derivatization with 2,4-dinitrophenylhydrazine. Our results point out that there is a highly significant decrease (p less than 0.001) of average retinol serum levels in all three patient groups as compared with group A, whereas carotenoids resulted decreased but not significantly. Tocopherol was found to be significantly lower only in groups B (p less than 0.05) and D (p less than 0.01), ascorbic acid in groups B (p less than 0.01) C (p less than 0.05) and D (p less than 0.001).

A comparative study of Atropa belladonna and atropine on an animal model of urinary retention.

The ability of Atropa belladonna L. and atropine to produce urinary retention has been studied in the rat. Our results suggest that A. belladonna is more effective than expected on the basis of its alkaloidic content.

Croton macrostachys, a plant used in traditional medicine: purgative and inflammatory activity.

Croton macrostachys seeds are widely used in Somalia as a purgative. In the present study, pharmacologic and chemical investigations confirm the laxative effect of the seeds and indicate the presence of phorbolesters. There appears to be no direct correlation between phorbolester content and laxative effect.

[Research in experimental electrocardiography. II: effect of a beta-blockader (pindolol) on the electrocardiogram of the rat]. / Ricerche di elettrocardiografia sperimentale. Nota II: Effetti di un beta-bloccante (il pindololo) sull'elettrocardiogramma del ratto.

From the Authors' observations during this research, there emerges the fact that pindololo does not seem deprived of that cardiodepressive action, which is typical of all beta-blocking drugs.

[Vitamin C in the plasma and leukocytes of Italians in different periods of the year]. / La vitamina C nel plasma e nei leucociti degli Italiani in differenti periodi dell'anno.

After briefly mentioning the factors which influence the vitamin C levels in tissues, the findings are reported of an investigation, conducted on 11 volunteers, in which some variations were revealed in vitamin C concentrations in the plasma and in the leukocytes of the subjects examined during a period of one year. The lowest levels were found in the months of March and December.

[Therapeutic action of vitamin C on cholesterol metabolism]. / Azione terapeutica della vitamina C sul metabolismo del coleste rolo.

As a part of the research work on the role played by Vitamin C on lipidic metabolism, the effects on man were considered that result from the administration of high vitamin C doses, chiefly with reference to the serum levels of colesterol, of total lipids and of triglycerides. Our research was conducted on male subjects of 65-90 years, who were administered 3 g/day of vitamin C for three weeks. Our findings show that the administration of high vitamin C doses causes a statistically significant decrease in colesterol, in total lipids and in triglycerides, in all the subjects under consideration. This takes place not only when colesterol, total lipids and triglycerides present normal serum levels, but also when such levels show an increase. Conversely, vitamin C significantly increases, with treatment, in all subjects treated, both in plasma and in leukocytes.

[Research in experimental electrocardiography. I: action of DCA-ajmaline on the electrocardiogram of the rat]. / Ricerche di elettrocardiografia sperimentale. Nota I: azione della DCA-ajmalina sull'elettrocardiogramma del ratto.

In the course of their experiments, the Authors did not observe any modifications in the rat electrocardiogram, induced by a 2,5 mg DCA-ajmaline intravenous injection, nor, in particular, any negative bathmotropic action due to it.