What evidence do economic evaluations in dental care provide? A scoping review.

OBJECTIVE: To collate the body of evidence in economic studies of different dental interventions. METHODS: Eligible English studies after 1980 were sourced from MEDLINE using MeSH terms and reviewed independently by 4 teams. Studies were grouped according to the type of dental intervention and their quality appraised using Drummond's Checklist. RESULTS: The number of dental economic studies increased from 1980 to 2016. A total of 91 studies were identified following the search strategy. Most studies were conducted in the United States (n=23), followed by Germany (n=14), Australia (n=10) and the United Kingdom (n=9). Preventative dental interventions comprised 37% of included studies (n=34), followed by restorative (n=14), prosthodontic (n=13) and periodontal interventions (n=12). Cost effectiveness analyses (n=68) comprise 75% of full economic evaluation (EE) studies, followed by cost-utility (n=17) and cost-benefit (n=6). Quality assessment checklists identified 60 studies as good, 23 as moderate and 8 as poor. Common methodological limitations were identified in EE studies. Comparison of studies identified trends and common findings within each dental intervention. CONCLUSION: High quality economic studies are important in directing resources and funding by policy makers. Standardisation of reporting outcome measures will improve the potential for interpretation and comparison between studies. Research adhering to recommended quality assessment checklists will improve the overall quality of evidence to better identify cost-effective treatments for different dental interventions.

Effect of metformin and sitagliptin on doxorubicin-induced cardiotoxicity in adult male albino rats.

The use of doxorubicin (DOX) as an antitumor therapeutic agent is limited due to its cardiotoxic effects. Metformin (Met) and sitagliptin (Sitg) are suggested to improve cardiac function. The present study aimed to determine the potential protective effects of Met and Sitg on DOX-induced cardiotoxicity. Rats were divided into six groups: groups I, II, and III received normal saline, Met, and Sitg, respectively. Groups IV, V, and VI received DOX only, Met + DOX, and Sitg + DOX, respectively. Heart tissue was used for biochemical assays which measured cardiac reduced glutathione (GSH), thiobarbituric acid reactive substances (TBARS), and tumor necrosis factor α (TNF-α). Serum creatinine kinase (CK) and lactate dehydrogenase (LDH) were also measured. The heart apex was prepared for histological (hematoxylin and eosin) and immunohistochemical examination. Intoxication of DOX was associated with a significant elevation in serum CK-MB and LDH, reduction in cardiac GSH, and increased TBARS and TNF-α compared to the controls. Administration of Met or Sitg to DOX-intoxicated rats suppressed serum CK-MB and LDH. Moreover, cardiac GSH was elevated with decreased TBARS and TNF-α. These results were confirmed by histological study. Met and Sitg caused inhibition of caspase 3 and upregulation of B-cell lymphoma 2 (Bcl-2) expression in DOX-intoxicated animals. Sitg was found to exert a significantly better protective effect compared to that of Met. It was concluded that Sitg might be more effective than Met in reducing myocardial injury in DOX-induced cardiotoxicity in rats.

General public knowledge, preferred dosage forms, and beliefs toward medicines in western Saudi Arabia.

OBJECTIVE: To measure general public knowledge, source of knowledge, preferred dosage forms, and beliefs toward medicines. METHODS: A cross-sectional study design using convenience-sampling technique was used. A pre-validated questionnaire was designed and distributed to the general public through face-to-face interviews. All data were analyzed, and p-values less than 0.05 were considered significant. The study took place in the Clinical Pharmacy Department, Taif University, Taif, Kingdom of Saudi Arabia between August 2012 and February 2013 RESULTS: Nine hundred participants successfully responded to this study. Males represented two-thirds of the respondents (66.8%). In addition, 52% of respondents were of high education level. Modern (74.2%) and alternative medicines (88.7%) were understood by most respondents. Tablets (69.6%) and capsules (37.6%) represented the highest preferred dosage forms. In addition, physicians (66.6%) and pharmacists (46.2%) were the main sources of information regarding medicines. In terms of beliefs, respondents showed wrong beliefs in many statements used in this study. CONCLUSION: There is a need to improve public knowledge and beliefs toward medicines as well as utilizing public preferred dosage forms. In addition, pharmacists should play a major role in these programs since they are experts on medicines and play a more active role in patient education and counseling.

Blue rubber bleb nevus syndrome: extensive small bowel vascular lesions responsible for gastrointestinal bleeding.

Blue Rubber Bleb Nevus Syndrome is a rare condition characterised by multiorgan venous malformations, in particular of cutaneous area and the gastrointestinal (GI) tract. We report here a child with chronic iron deficiency anaemia, melena and skin lesions. She had severe hypochromic microcytic anaemia. Upper and lower endoscopy revealed hundreds of red-bluish polypoid lesions involving the entire GI tract primarily of the small bowel. Due to localisation of the most severe lesions, the patient responded well to surgical treatment, allowing a sustained clinical remission.

Baseline soil variation is a major factor in arsenic accumulation in Bengal Delta paddy rice.

Factors responsible for paddy soil arsenic accumulation in the tubewell irrigated systems of the Bengal Delta were investigated. Baseline (i.e., nonirrigated) and paddy soils were collected from 30 field systems across Bangladesh. For each field, soil sampled at dry season (Boro) harvest i.e., the crop cycle irrigated with tubewell water, was collected along a 90 m transect away from the tubewell irrigation source. Baseline soil arsenic levels ranged from 0.8 to 21. mg/kg, with lower values found on the Pliestocene Terrace around Gazipur (average, 1.6 +/- 0.2 mg/kg), and higher levels found in Holecene sediment tracts of Jessore and Faridpur (average, 6.6 +/- 1.0 mg/kg). Two independent approaches were used to assess the extent of arsenic build-up in irrigated paddy soils. First, arsenic build-up in paddy soil at the end of dry season production (irrigated - baseline soil arsenic) was regressed against number of years irrigated and tubewell arsenic concentration. Years of irrigation was not significant (P = 0.711), indicating no year-on-year arsenic build-up, whereas tubewell As concentration was significant (P = 0.008). The second approach was analysis of irrigated soils for 20 fields over 2 successive years. For nine of the fields there was a significant (P < 0.05) decrease in soil arsenic from year 1 to 2, one field had a significant increase, whereas there was no change for the remaining 10. Over the dry season irrigation cycle, soil arsenic built-up in soils at a rate dependent on irrigation tubewell water, 35* (tubewell water concentration in mg/kg, triple bond mg/L). Grain arsenic rises steeply at low soil/shoot arsenic levels, plateauing out at concentratations. Baseline soil arsenic at Faridpur sites corresponded to grain arsenic levels at the start of this saturation phase. Therefore, variation in baseline levels of soil arsenic leads to a large range in grain arsenic. Where sites have high baseline soil arsenic, further additional arsenic from irrigation water only leads to a gradual increase in grain arsenic concentration.

Arsenic mobilization from iron oxyhydroxides is regulated by organic matter carbon to nitrogen (C:N) ratio.

Arsenic (As) is mobilized from delta and floodplain aquifer sediments throughout S.E. Asia via reductive dissolution of As bound to iron (Fe) oxyhydroxides. The reductive driving force is organic carbon, but its source and constitution is uncertain. Here batch incubation experiments were conducted to investigate the role of organic matter (OM) carbon:nitrogen (C:N) ratio on the mobilization of arsenic, Fe and N from As dosed, Fe oxyhydroxide coated sands. As mobilization into pore waters from the sand was strongly regulated by the C:N ratio of the OM, and also the concentration of OM present. The lower the C:N, the more As released. Fe and ammonium release were similarly dependent on the quality and quantity of OM, but Fe mobilization was more rapid and ammonium release slower than As suggesting that the mobilization of these 3 moieties although interdependent, were not directly linked. It was concluded that low C:N ratios for OM responsible for reducing aquifers were As in groundwater is observed were likely.

Enhanced transfer of arsenic to grain for Bangladesh grown rice compared to US and EU.

A field survey was conducted in arsenic impacted and non-impacted paddies of Bangladesh to assess how arsenic levels in rice (Oryza sativa L.) grain are related to soil and shoot concentrations. Ten field sites from an arsenic contaminated tubewell irrigation region (Faridpur) were compared to 10 field sites from a non-affected region (Gazipur). Analysis of the overall data set found that both grain and shoot total arsenic concentrations were highly correlated (P<0.001) with soil arsenic. Median arsenic concentrations varied by 14, 10 and 3 fold for soil, shoot and grain respectively comparing the two regions. The reason for the sharp decline in the magnitude of difference between Gazipur and Faridpur for grain arsenic was due to an exponential decline in the grain/shoot arsenic concentration ratio with increasing shoot arsenic concentration. When the Bangladesh data were compared to EU and US soil-shoot-grain transfers, the same generic pattern could be found with the exception that arsenic was more efficiently transferred to grain from soil/shoot in the Bangladesh grown plants. This may reflect climatic or cultivar differences.

Impact of unleaded gasoline introduction on the concentration of lead in the air of Dhaka, Bangladesh.

Airborne particulate matter (APM) samples collected at a semiresidential area in Dhaka, Bangladesh, during the periods of 1994 and 1997-2000 have been studied to assess the impact of the use of unleaded gasoline in Bangladesh. According to scanning electron microscopy/ energy-dispersive X-ray microanalyzer studies, lead (Pb) was found as Pb sulfates and Pb halides in motor-vehicle exhaust particles, whose diameters were some hundreds of nanometers. No significant changes in the annual averages of APM mass and black carbon concentrations have been observed over the period. The yearly average Pb concentration reached a maximum value of 370 ng/m3 in the particulate matter with an aerodynamic diameter < 2.5 microm fraction in 1998. In 2000, the concentration decreased to approximately one-third (106 ng/m3) of the high earlier values after the introduction of unleaded gasoline in 1999. A significant lowering of the blood Pb level of the population over next few years is expected as a result of this great decrease in Pb concentration.

Carney's triad with recurrent gastric leiomyoblastoma.

The triad of gastric leiomyoblastoma, extra-adrenal paraganglioma, and pulmonary chondroma was first described by Carney in 1977. Fewer than 30 patients with this syndrome have since been reported. In most patients the initial lesion has been a gastric leiomyoblastoma. The patient we describe had recurrences of a gastric leiomyoblastoma 15 and 17 years, respectively, after the initial gastric resection. Subsequently, multiple pulmonary lesions were excised and confirmed to be chondromas, but no evidence of a paraganglioma has yet been identified. Gastric leiomyoblastomas in patients with Carney's triad frequently recur; however, the prognosis is quite favorable in contrast to that of sporadic cases. Whenever a patient with one of the classical lesions of Carney's triad is encountered, the possibility of this unusual syndrome should be considered. The evaluation and follow-up of these patients should include a search for the other two components.