Scurvy in an 18-month-old child mimicking a clinical presentation of rickets.

Scurvy is now considered to be a rare disease in European countries, even among children, but it still exists. We report the case of an 18-month-old boy who was initially hospitalized for a walking disorder and ultimately diagnosed with scurvy. Radiographs were compatible with rickets, but biological analysis ruled out this diagnosis.

Rhinovirus: A Narrative Review on Its Genetic Characteristics, Pediatric Clinical Presentations, and Pathogenesis.

Human rhinoviruses (HRVs) are the leading cause of common colds. With the development of new molecular methods since the 2000s, HRVs have been increasingly involved among severe clinical infections. Recent knowledge of the HRV genetic characteristics has also improved the understanding of their pathogenesis.

Cost-utility analysis of second-line therapy with rituximab compared to tumour necrosis factor inhibitors in rheumatoid arthritis.

Objective: To compare direct costs and treatment utility associated with the second-line therapy with rituximab and tumour necrosis factor inhibitors (TNFis) (adalimumab, etanercept, and infliximab) in patients with Rheumatoid Arthritis (RA) using data from a prospective registry.

Methods: Health Assessment Questionnaire Disability Index (HAQ-DI) scores and RA-related healthcare resource utilization data (biologic agents and visits to rheumatologists) were extracted from a registry (Quebec, Canada) for patients with RA ( = 129) who had to discontinue a first-line TNFi and were treated with rituximab, adalimumab, etanercept, or infliximab as the second-line therapy between January 2007 and May 2016. A decision analytic model followed patients for 1 and 6 years.

Assessing the risk of multiple sclerosis disease-modifying therapies.

: The number of immunomodulatory options approved for multiple sclerosis has increased over the past years, resulting in a better control of the disease. Depending on disease activity, neurologists can now propose treatments with different levels of efficacy, from injectable and oral treatments with modest efficacy, to highly active immunosuppressants. Nevertheless, this gain in efficacy has come with an increase in the global burden of treatment-related adverse events.

A theoretical exploration of therapeutic monomania as a physician-based instrumental variable.

Purpose: To explore the utility of physician prescribing preference as an instrumental variable.

Methods: Expert (non-systematic) review of relevant literature on the appropriate selection of instrumental variables and theoretical exploration of individual physician and physician group prescriber preference.

Results: An instrumental variable must satisfy three criteria: (1) It must predict the treatment received (strength of the instrument); (2) it cannot influence the outcome other that through the treatment received (exclusion restriction); and (3) it cannot be influenced by any factor that also influences the outcome (independence assumption).

The burden of symptomatic skeletal events in castrate-resistant prostate cancer patients with bone metastases at three Canadian uro-oncology centres.

Introduction: Metastatic bone disease in castrate-resistant prostate cancer risks significant morbidity, including symptomatic skeletal events. We estimated the healthcare resource costs of managing skeletal events.

Methods: A retrospective chart review was conducted for patients who died from or were treated palliatively for metastatic castrate-resistant prostate cancer from 2006-2013 at Centre Hospitalier de l'Université de Montréal (Montreal), Princess Margaret Cancer Centre (Toronto), or Vancouver General Hospital (Vancouver).

Medication Persistence, Duration of Treatment, and Treatment-switching Patterns Among Canadian Patients Taking Once-daily Extended-release Methylphenidate Medications for Attention-Deficit/Hyperactivity Disorder: A Population-based Retrospective Cohort Study.

Purpose: We conducted a retrospective cohort study to compare medication use patterns of a long-acting extended-release methylphenidate (Osmotic Release Oral System [OROS(®)] methylphenidate, CONCERTA(®)) and Teva-methylphenidate (methylphenidate ER-C), a generic drug determined by the Canadian regulatory authority, Health Canada, to be bioequivalent to OROS(®) methylphenidate.

Methods: We established an OROS(®) methylphenidate-experienced and new-user population cohort to compare medication use patterns, including medication persistence, duration of therapy, and treatment-switching patterns. Multivariable log-binomial regression was used to adjust for confounders of the associations with persistence.

Effect of cinacalcet availability and formulary listing on parathyroidectomy rate trends.

Background: Recent trends in parathyroidectomy rates are not known. Our objective was to investigate the trend in parathyroidectomy rates between 2001 and 2010, and to evaluate if the availability and reimbursement of cinacalcet modified that trend.

Methods: Using a provincial administrative database, we included all adult patients receiving chronic dialysis treatments between 2001 and 2010 (incident and prevalent) in a time series analysis.

Carotenoid and fatty acid metabolism in light-stressed Dunaliella salina.

beta-Carotene is overproduced in the alga Dunaliella salina in response to high light intensities. We have studied the effects of a sudden light increase on carotenoid and fatty acid metabolism using a flat panel photobioreactor that was run in turbidostat mode to ensure a constant light regime throughout the experiments. Upon the shift to an increased light intensity, beta-carotene production commenced immediately.

Effect of hemodialysis, coronary artery disease and diabetes on cardiac troponin T: a prospective survey over one year.

Background: Limited data is available about the effects of hemodialysis sessions, coronary artery disease (CAD), and diabetes on serum cardiac troponin T (cTnT) levels in patients with end-stage renal disease (ESRD).

Objectives: To test whether hemodialysis could be associated with an increase in cTnT concentration. To evaluate if coronary artery disease (CAD) or diabetes are associated with higher cTnT levels in ESRD.

Modifiable factors predicting patient survival in elderly kidney transplant recipients.

Background: Elderly transplant candidates represent an increasingly important group on the waiting list for kidney transplantation. Yet the factors that determine posttransplantation outcomes in this population remain poorly defined.

Methods: We performed a population-based retrospective cohort study involving all patients aged 60 years or older who received a first cadaveric kidney transplantation between 1985 and 2000 in the province of Quebec.

Levetiracetam: an innovative and cost-effective add-on drug for refractory partial epilepsy.

Poorly-controlled epilepsy can have a significant negative impact on quality of life, clinically important changes are seen in patients emotional well-being, cognitive functioning, social functioning and energy/fatigue levels. Poorly-controlled epilepsy places an undue economic burden on the patient and community. Increased costs are seen in both direct and indirect healthcare costs (e.

Antihypertensives and myocardial infarction risk: the modifying effect of history of drug use.

Purpose: Confounding by indication is common in observational studies of outcomes that treatment is intended to affect. In light of the stepped-care approach to hypertension management, we reexamined the controversy around myocardial infarction (MI) risk in relation to antihypertensive agents by considering past drug history both as a confounder and as an effect modifier.

Methods: Case-control design nested within a cohort of 19,501 adults initiating therapy with angiotensin-converting enzyme inhibitors (ACEI), calcium channel blockers (CCB) or beta-blockers in Saskatchewan (1990-93) and followed up to 1997.

Efficacy and cost of HMG-CoA reductase inhibitors in the treatment of patients with primary hyperlipidemia.

Background: Screening for hyperlipidemia is a substantial cost burden, as is its treatment. The choice of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and the dose level may have significant implications for both efficient and cost effective therapy.

Objective: To compare the efficiency and cost of statins.

Reference-based pricing of prescription drugs: exploring the equivalence of angiotensin-converting-enzyme inhibitors.

Background: Reference-based pricing is a cost-containment policy applied to prescription drugs that are in the same class and deemed to be therapeutically equivalent. Recent reference-based pricing measures have targeted several drug classes, including angiotensin-converting-enzyme (ACE) inhibitors. The objective of this study was to assess whether patients treated for hypertension with various ACE inhibitors differed in their utilization of health care services and hence, whether the various ACE inhibitors should be considered therapeutically equivalent.

Evaluation of zolpidem, triazolam, and placebo as hypnotic drugs the night before surgery.

Study Objective: To compare the hypnotic effects of a bedtime dose of zolpidem, triazolam, and placebo.

Design: "Double-blind, randomized, placebo- and active-controlled, parallel-group" trial.

Setting: Six Canadian hospitals.

Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews.

Background: Lately, the number of systematic reviews published has increased substantially. Many systematic reviews exclude trials published in languages other than English. However, there is little empirical evidence to support this action.

How to assess the economics of hypertension control programmes.

In this paper we summarise the discussion in the session about how to assess the economics of hypertension control programmes. The paper is structured around the four main themes discussed in the session: the methods of economic evaluation, the estimation of costs in an economic evaluation, the estimation of effects in an economic evaluation, and the relationship between economic evaluation and policy-making.

Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias?

Although they usually claim a very thorough search to retrieve every pertinent work, most meta-analyses published in English restrict their search to papers which were also published in English. We reviewed all the meta-analyses printed from 1 January 1991 to 1 April 1993 in 8 medical journals published in English and selected those who stated linguistic restrictions for inclusion in the analysis. The computerized search methods used in these meta-analyses were then duplicated looking specifically for publications written in the excluded languages.