Purpose Kyrgyzstan and Tajikistan are Central Asian low-income countries. Breast cancer is the most common cancer in the Kyrgyz Republic and in Tajikistan. Almost 40% of breast cancer cases are detected in advanced stages. The Kyrgyzstan and Tajikistan health care systems do not guarantee equal access to treatment to all people, and patients with breast cancer have to pay out of pocket for the entire course of chemotherapy treatment. Therefore, evaluation of the cost of a chemotherapy regimen represents a first step in the policy discussion and the creation of a government copayment system that would guarantee access to chemotherapy and ensure the effective and sustainable basic-level treatment of most patients. Methods Resource and Policy Exchange, Tajik, and Kyrgyz experts calculated the average drug dose per patient for adriamycin and cyclophosphamide; cyclophosphamide, methotrexate, and fluorouracil; and fluorouracil, adriamycin, and cyclophosphamide regimens recommended by the Breast Health Global Initiative as basic-level therapy and the taxanes average dose—docetaxel and paclitaxel—as enhanced-level therapy. The drug procurement cost per cycle was calculated for each chemotherapy regimen on the basis of on an average dose per patient (standard 1.75 m2), the average number of doses per cycle, and the average list price per milligram. Experts acquired cancer drug price lists from different pharmacies using the lowest generic prices available in Kyrgyzstan and Tajikistan. Results The cost of the basic chemotherapy regimen adriamycin and cyclophosphamide is $249 USD in Kyrgyzstan and $222 USD in Tajikistan. That of the cyclophosphamide, methotrexate, and fluorouracil regimen is $587 USD in Kyrgyzstan and $486 USD in Tajikistan. That of the fluorouracil, adriamycin, and cyclophosphamide regimen is $326 USD in Tajikistan and $526 USD in Kyrgyzstan. However, the cost of the taxanes regimen—enhanced level—is more expensive. The cost of a paclitaxel monotherapy regimen is $4896 USD in Kyrgyzstan and $4,695 USD in Tajikistan, and that of a docetaxel monotherapy regimen $1,411 USD in Kyrgyzstan and $1,086 USD in Tajikistan. Conclusion Chemotherapy regimen cost calculation is an integral part of advocacy and policy work. It helped to negotiate basic-level chemotherapy treatment insurance coverage for women with breast cancer. The cost of a monotherapy taxanes regimen is expensive and requires additional financial resources. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
Республиканский специализированный научно-практический медицинский центр педиатрии МЗ Руз, Ташкент, Узбекистан Исследование генетического полиморфизма rs231775 (+49A > G) и rs5742909 (+318С > Т) гена CTLA-4 у 100 больных детей с хронической HBV-инфекцией выявило ассоциации только с носительством полиморфного варианта +49А/G. При этом, носительство G-аллеля в гомозиготной мутантной +49GG-позиции предполагало развитие выраженных форм с прогрессирующим течением и высокой вероятности исхода заболевания в цирроз печени. Установленные гендерные различия-свойственная мальчикам высокая экспрессия минорного G-аллеля гена CTLA-4, особенно в гомозиготной мутантной вариации +49GG-доказывает феномен высокой частоты поражения мальчиков гепатотропной вирусной инфекцией. Следовательно, носительство мутантной вариации +49GG можно рассматривать в числе HOST-факторов по прогнозированию неблагоприятных исходов хронической HBV-инфекции у детей. Ключевые слова: хроническая HBV-инфекция, ген CTLA-4, полиморфизмы rs231775 (+49A > G) и rs5742909 (+318С > Т), клиника, дети Polymorphisms rs231775 and rs5742909 CTLA-4 gene and their associative relations with chronic HBV infection in children
Objective: To assess diagnostic importance of iron metabolism markers in the progression of anemia of inflammation (AI) in children with chronic HBV infection.Materials and methods: Among 148 examined children with chronic HBV infection 140 had AI, 60.7% of them with refractory (RA) and 39.3% with non-refractory (nRA) progression variant. Complete blood count was performed using hematologic automatic analyzer. Virologic verification of HBV was done by ELISA and PCR. ELISA was used to determine 25-hepcidin, serum iron, ferritin, trasferrin, sTfR, IL-1, IL-6. The index sTfR/log10Ft was calculated.Results: Performing the examination of children with chronic HBV infection we determined high prevalence of AI, equal to 94.6%, which was characterized by normocyte normochromic progression, thrombocytopenia, thrombocrit decrease in case of RA, and microcyte hypochromic progression with erythrocyte anisocytosis in case of nRA. Despite the high inflammatory index induced by HBV viral replication, children with RA had characteristic decrease in 25-hepcidin and transferrin parameters with background high values of ferritin, while nRA was characterized by rise of 25-hepcidin and transferrin spectrum with low values of serum iron and ferritin.Conclusions. In the genesis of AI in chronic HBV cases two pathogenic variants were determined: true iron deficiency with ferromarkers in the type of IDA characteristic for nRA and redistribution iron deficiency compliant to hemosiderosis characteristic for RA. Priority in the differential diagnosis of AI variants is given to the comparison of sTfR/log10Ft index parameters (RA<1.0; nRA>2.0) with reference level of 25-hepcidin<28,68ng/ml in case of RA, and >56,37ng/ml in case of nRA.
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