Introduction: Triple inhaled corticosteroid/ long-acting muscarinic antagonist/long-acting b 2agonist (ICS/LAMA/LABA) combination therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience further exacerbations/symptoms on dual LAMA/ LABA or ICS/LABA therapy. The relative efficacy of budesonide/glycopyrronium/formoterol fumarate metered dose inhaler 320/18/9.6 lg (BGF

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Background. Hepatic encephalopathy (HE) is a frequent and debilitating complication of liver disease. Treatments include lactulose and rifaximin-α. The objective of this literature review and meta-analysis was to assess the overall cost-effectiveness of rifaximin-α in HE treatment. Methods. Electronic database searches were conducted in November 2020 to identify cost-effectiveness studies comparing rifaximin-α with other interventions in HE, published in English. Incremental net benefit (INB) was calculated for each study using difference in effectiveness, difference in costs, and the willingness-to-pay threshold, or gross domestic product per capita for each country, and 95% confidence intervals (CI) were constructed. Costs were standardised to 2019 US$. An intervention was considered cost-effective if the INB was positive. Meta-analysis was used to pool calculated INB across studies, using a fixed-effects model if there was no heterogeneity or a random-effects model. Results. Eleven studies were included in the meta-analysis. For rifaximin-α plus lactulose in the second-line setting, the pooled INB was estimated at $20,156 (95% CI: $13,593-$29,887) versus lactulose monotherapy. For rifaximin-α monotherapy in the first-line setting, the pooled INB was $4834 (95% CI: $1601-$14,596) versus lactulose monotherapy. Due to lack of available data, meta-analyses were not possible for rifaximin-α added to lactulose therapy versus lactulose monotherapy in the first-line setting or for rifaximin-α as salvage therapy in the second-line setting. Conclusions. Rifaximin-α as an add-on treatment to lactulose in the second-line setting or as monotherapy in the first-line setting would be a cost-effective treatment for HE compared with lactulose monotherapy.

Background: Intrahepatic cholestasis of pregnancy is a multifactorial condition of pregnancy diagnosed when otherwise unexplained pruritus with abnormal liver function test and neither of which has an alternative cause. The most appropriate gestational age for the delivery of women with ICP is yet to be determined. The present study is designed to determine whether with active intervention, pregnancy with ICP can be carried to a later gestation.Methods: Fifty Women with diagnosed a case of ICP were recruited into the study. The diagnosis of ICP was based on the symptoms, clinical examination and lab investigations. Group I: 25 women planned for delivery at POG 37 - 37+6 weeks of pregnancy. Group II: 25 women Planned for delivery at POG ≥38 weeks of pregnancy.Results: In group, one woman had preterm delivery at POG 36+2 weeks and rest of 24 women were delivered at POG 37-37+6 weeks. In group II, out of 25 women one woman had emergency LSCS at POG 35+3 weeks for MSL and induction of labour was done in 2nd for abnormal fetal well-being tests at POG 37 weeks. One woman had pre-term delivery at POG 36+1 weeks. Remaining 22 women in group II were delivered at POG ≥38 weeks. In the present study there was no significant difference in the gestational age at delivery between the two groups.Conclusions: It can be concluded that pregnancies with obstetric cholestasis can be carried to later gestation of ≥38 weeks under surveillance with UDCA treatment.

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