The marked variability of outcome of disseminated Bacillus Calmette-Guerin disease in interleukin-12/23 receptor beta1-deficient children sharing the same ethnic origin and exposed to a similar environment as presented in these case reports has to be taken into consideration for diagnosis and treatment of infections due to this genetic defect.

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The usage of zip guns-homemade self-constructed firearms fashioned out of pieces of metal with a simple firing pin or made by conversion of blank guns into a harmful weapons, is quite rare and sporadic in forensic pathology. To avoid the control and registration of firearm, people with technical skills can make one at home. The atypical homemade firearm can lead to atypical autopsy findings with unusual gunshot wounds on the body. The following article presents an original case of an unusual self-inflicted gunshot suicide committed with a homemade improvised zip gun during a regular traffic stop of the motorcycle. Technical examinations of the disassembled weapon revealed it to be partially handcrafted zip gun that had been constructed as a single barrel gun in shape of a pistol or revolver from metal piping and part of barrel with internal grooves, used from a regular assault rifle. Further police investigation revealed that the decedent did not have motorcycle papers and driving license with him in time of the traffic stop; but he has not had any psychiatric or suicidal history. In his locked room he had a lot of ammunition and old firearms, including one expansion rifle; although he never had a firearms license. The death was classified as a suicide with the handmade zip gun fired most likely from near-contact range to the right temporal region of the head, with complete penetration through the cranial cavity, under the influence of alcohol.

Due to the possibility to cure the disease, treatment duration in HCV is limited to a maximum of 48 weeks. The lengths of use of direct acting agents (DAA=s) are significantly different: 12 weeks with telaprevir vs. 24, 32 or 44 weeks with boceprevir. These factors make the implementation of futility rules in economic models critical. OBJECTIVES: To provide an insight on the proper application of the futility rules in economic evaluations of DAA=s. METHODS: A decision tree model was developed to assess cost-efficacy for each DAA, considering 4 patient types: naïve, relapsers, partial responders, and null responders. Average acquisition costs have been estimated with and without the use of futility rules; if these rules are used, corresponding salvage treatment costs were included. The efficacy of triple therapy treatment was defined by patient type based on each DAA's summary of product characteristics. Cost per patient with sustained virological response (SVR) and the number of cured and not cured patients was calculated with a fixed budget. RESULTS: For a 10 million EUR investment in each patient type for either DAA, using telaprevir offers maximum cured (726 vs. 587) and minimum non-cured patients (399 vs. 517) if futility rules are not considered. If the futility rules are used, there are still maximum cured patients (759 vs. 734) and minimum non-cured patients (450 vs. 697) when telaprevir is used. We performed one-way and two-way sensitivity analyses and the overall conclusion does not change vs. boceprevir. CONCLUSIONS: Telaprevir offers maximum cured and minimum non-cured patients regardless of the futility rule consideration when compared to boceprevir. If stopping rules are considered in economic evaluations for the treatment of HCV, an appropriate horizon timeline should also be considered to capture future unavoidable costs of non-cured patients: salvage treatment and/or potential disease progression.OBJECTIVES: Invasive Fungal Infections (IFIs) present a major issue in clinical practice, due to their high morbidity and mortality rates. In a pivotal multicentre, randomized clinical trial posaconazole prophylaxis prevented IFIs more effectively than did either fluconazole or itraconazole, and improved overall survival. The aim of this study was to perform an economic evaluation of the afore-mentioned therapeutic strategies for IFI prophylaxis in neutropenic patients, in the Greek health care setting. METHODS: A decision analytic model was developed, which described the course of neutropenic patients under posaconazole or standard azole (fluconazole or itraconazole) treatment. The effectiveness data for each treatment regimen were derived from published results of a pivotal, multicentre, randomized clinical trial. The cost and health care resources utilization data used, depict Greek clinical practice and are derived from official Greek sources. In order to obtain some of the model imputs, expert opinion from Greek Hematologists specializing in treating IFIs, was also used. RESULTS: Prophylaxis with Pos...