Cost Efficiency and Cost Effectiveness of Cataract Surgery at the Malaysian Ministry of Health Ophthalmic Services

PURPOSE: To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery (ECCE) and phacoemulsification at three hospitals of the Malaysian Ministry of Health (MOH). METHODS: Patient demography, pre-operative visual acuity, intra-operative complications, post-operative complications and post-operative visual acuity were recorded for two hundred and forty seven of the 400 patients who underwent cataract surgery during a 2-week period. The cost of surgery, which included capital, staff and overhead, and patient care consumable costs were assessed prospectively in 8 randomly sampled patients over a 3-month period. Cost efficiency refers to cost per cataract surgery. Cost effectiveness refers to cost per successful cataract surgery. This is estimated by the ratio of cost efficiency to the proportion of successful cataract surgery. Successful surgery was defined as best-corrected visual acuity (BCVA) of better than 6/12 at 3 months post-operatively. RESULTS: Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group (94%) than in the ECCE group (81%). Conventional extracapsular cataract surgery with intraocular lens implant costs RM3442 (USD 905.79) and phacoemulsification with intraocular lens implant costs RM4288 (USD 1128.42). DISCUSSION: There was no significant difference in cost effectiveness between ECCE and phacoemulsification. The cost of cataract surgery in the MOH hospital was found to be high due to the high overhead costs.     

Dietary and other factors associated with overweight among women workers in two electronics factories in selangor

This study was a cross-sectional survey conducted among 122 women workers employed in the electronics factories in the Ulu Klang Free Trade Zone (FTZ) and the Bangi FTZ, Selangor, Peninsular Malaysia. The purpose of the study was to examine the problem of overweight (>25.0 kg/m2) among this group of women, and factors (socio-demographic, work, exercise, and dietary) associated with overweight, and, to study the food intake pattern of the women in both the overweight and non-overweight groups. Data was collected using a set of questionnaires, while anthropometric measurements were obtained to calculate body mass index (BMI) and waist hip ratio (WHR). The results of the study indicated that 64.0% of the women were overweight (29.5% pre-obese, 34.5% obese). About one-tenth of the women (11.5%) had a WHR of above 0.85. From the bivariate analysis, it was found that women who were older, ever married, had lower educational level, had higher salary, not living in the hostel, involved in shiftwork, and trying to lose weight were more likely to be overweight. After adjusting for age, each of the above factors, except for educational level, remained significantly associated with overweight. Women's diet was found to be monotonous and lacking in variety as accessibility to and availability of a variety of food was a problem for them due to the nature of their work. They also had a sedentary lifestyle. Therefore, further research focusing on changing the poor dietary habits and sedentary lifestyle of the women workers is necessary to address the problem of overweight.     

A free radical mediated cooxidation of tetramethylhydrazine by prostaglandin hydroperoxidase

Prostaglandin endoperoxide synthase catalyzed the oxidationof tetramethylhydrazine to the tetramethylhydrazine radicalcation, as detected by electron spin resonance spectroscopy.Oxidation of tetramethylhydrazine by prostaglandin endoperoxidesynthase also resulted in the N-demethylation of tetramethylhydrazineleading to the formation of formaldehyde. Both the radical andformaldehyde formation were dependent on arachidonic acid, inhibitedby indomethacin, and supported by 15-hydroperoxyarachidonicacid, indicating that the metabolism was peroxidative. We proposethat tetramethylhydrazine undergoes two sequential one-electronoxidations yielding an iminium cation, which is then hydrolyzedto yield formaldehyde. Metabolism of hydrazines by prostaglandinendoperoxide synthase may be of importance in tissues containinglow mixed-function oxidase activity.     

Elevated serum total and LDL cholesterol in very old patients with Alzheimer's disease

The relationships of serum lipids with Alzheimer's disease (AD) and other dementias in very old patients are not clear. All residents of an academic nursing home were studied clinically for dementia and for serum lipids. All those autopsied over a 7.7-year period had apolipoprotein E (apoE) genotyping and detailed neuropathological examination. Those with pathologically defined criteria for AD (n = 84) were compared to all others who also had clinical dementia but did not show AD changes (n = 22). In contrast to most other reports of serum lipids in very old patients with AD, total cholesterol (TC) and low density lipoprotein cholesterol levels were each significantly higher for those with AD. The lipid-AD associations were progressively stronger with increasing pathological certainty of AD diagnosis. These relationships remained significant after adjustment for apoE genotype and for other known risk factors. The lipid-AD associations in a very old cohort, and prior evidence that elevated TC in middle life is a risk factor for later dementia, prompt consideration of factors associated with lipid metabolism in the development of Alzheimer's dementia.     

Diagnostic and therapeutic laparoscopy in assessment and management of patients with appendiceal neoplasms

Introduction: Radiological imaging often underestimates the extent of low volume peritoneal disease. The benefit of laparoscopy in assessing peritoneal metastases from colorectal and gastric cancer is accepted, but is inconclusive for appendiceal malignancy. We report our experience of diagnostic (DL) and therapeutic laparoscopy (TL) in patients with appendiceal tumours to determine indications and role in assessment and management.

Methods: A retrospective review of a National Peritoneal Malignancy Centre’s prospectively maintained database was performed. All patients with appendiceal neoplasms who underwent DL or TL between September 2011 and January 2016 were included. The indications and outcomes of the laparoscopy, complications and interval to laparotomy were evaluated.

Results: Six hundred and eighty-five patients underwent surgery for appendiceal neoplasms during the study period, of which 73 (10.6%) underwent laparoscopy (50 DL, 23 TL). The main indications for DL were to clarify imaging and stage patients with high-risk histology. Indications for TL were an abnormal appendix without gross pseudomyxoma peritonei (PMP) or with low volume PMP, and concerns for fertility in the presence of PMP. DL resulted in 16 patients (32%) avoiding laparotomy because of extensive disease or no tumour found. Overall, 28 patients were assessed to have resectable disease and at laparotomy, 25/28 had complete cytoreduction with three patients unresectable. In the TL group, appendicectomy and peritoneal lavage was achieved in all four women with fertility concerns, allowing them to conceive thereafter. There were no complications.

Conclusions: Patients with high-risk appendiceal neoplasm may benefit from DL, and potentially avoid unnecessary laparotomy. TL is useful in patients with low volume PMP and may aid fertility in selected patients.     

The pre-operative neutrophil–lymphocyte ratio predicts overall and disease-free survival following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with pseudomxyoma peritonei of appendiceal origin

Aim: The neutrophil–lymphocyte ratio (NLR) and other inflammation-based scores have been used as a prognostic tool to predict survival in solid tumours including pseudomyxoma peritonei (PMP). The aim was to evaluate the prognostic value of this marker and risk stratify PMP patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: Retrospective analysis was conducted of a prospectively collected database of patients with PMP who underwent CRS and HIPEC between 1994 and 2015. The NLR was calculated by dividing the pre-operative neutrophil count by lymphocyte count. Predicted overall survival (OS) and disease-free interval (DFI) were calculated using a Kaplan–Meier survival model.

Results: The study included 699 patients, stratified into four groups as defined by their NLR. Group A: 200 (28.6%) patients (NLR?=?0.10–2.00), Group B: 160 (22.8%) patients (NLR?=?2.10–2.78), Group C: 184 (26.3%) patients (NLR?=?2.79–4.31) and Group D: 155 (22.2%) patients (NLR?≥?4.32). The median follow-up for this cohort was 36?months. The predicted DFI was 132.2, 113.1, 84.4 and 47.9?months and the OS was 141.1, 117.6, 88.7 and 51.2?months for Groups A, B, C and D, respectively. As the NLR increases, there is a reduction in long-term survival.

Conclusion: The pre-operative NLR is cost effective and has equivalent prognostic value to pre-operative tumour markers for patients with PMP treated with CRS and HIPEC. The NLR is a reliable tool that may have a role in predicting outcomes following CRS and HIPEC for patients with PMP of appendiceal origin.     

Exceptionally potent human monoclonal antibodies are effective for prophylaxis and treatment of tetanus in mice

We used human monoclonal antibodies (humAbs) to study the mechanism of neuron intoxication by tetanus neurotoxin and to evaluate these antibodies as a safe preventive and therapeutic substitute for hyperimmune sera to treat tetanus in mice. By screening memory B cells from immune donors, we selected 2 tetanus neurotoxin–specific mAbs with exceptionally high neutralizing activities and extensively characterized them both structurally and functionally. We found that these antibodies interfered with the binding and translocation of the neurotoxin into neurons by interacting with 2 epitopes, whose identification pinpoints crucial events in the cellular pathogenesis of tetanus. Our observations explain the neutralization ability of these antibodies, which we found to be exceptionally potent in preventing experimental tetanus when injected into mice long before the toxin. Moreover, their Fab derivatives neutralized tetanus neurotoxin in post-exposure experiments, suggesting their potential for therapeutic use via intrathecal injection. As such, we believe these humAbs, as well as their Fab derivatives, meet the requirements to be considered for prophylactic and therapeutic use in human tetanus and are ready for clinical trials.     

Mechanisms Linking White Matter Lesions,Tract Integrity,and Depression in Alzheimer Disease

ObjectiveLate-life depression involves the disconnection of white matter tracts that regulate mood. A pathogenic link between poor tract integrity and depressive symptoms is believed to be white matter lesions (WML), however the mechanisms linking tract integrity, WML, and depression remains unexplored. The authors sought to identify whether the association between reduced tract integrity and depressive symptoms is mediated by WML in patients with Alzheimer disease (AD), and whether individual characteristics moderate this effect.MethodsThis was a cross-sectional study in a tertiary memory clinic. A total of 91 patients with mild AD and 79 healthy elderly, comparable in depressive symptoms, white matter hyperintensities (WMH) volume, cardiovascular risk, age, and sex were chosen. Tract integrity was assessed using diffusion tensor imaging, WML were indexed as WMH, measured using fluid-attenuation inversion recovery imaging, and depressive symptoms were measured with the informant-based Geriatric Depression Scale.ResultsIn patients with mild AD, reduced tract integrity in right hemispheric cortical-subcortical tracts and the genu of the corpus callosum was moderately associated with depressive symptoms. This association was fully mediated by WML. Moderation analysis indicated that old age strengthened the association between all tracts and depressive symptoms, as mediated by WML. In cognitively healthy elderly, neither tracts nor WML were related to depressive symptoms.ConclusionReduced tract integrity may be important but not sufficient for the manifestation of depressive symptoms in mild AD. Instead, WML may drive the pathogenic link between reduced tract integrity and depressive symptoms.     

Spontaneous immortalisation of ensheathing cells from adult rat olfactory nerve

In this report, we describe the isolation of a cell line, Rolf B1.T, from cultures of adult rat olfactory nerve cells. Rolf B1.T cells have an antigenic phenotype which closely resembles that of olfactory ensheathing cells. In routine culture conditions, Rolf B1.T cells constitutively express glial fibrillary acidic protein, S100, the low-affinity neurotrophin receptor p75 NGF′, laminin, tenascin, and the neural cell adhesion molecule (N-CAM); a variable proportion of the cells also express cadherin, which is regulated by local culture conditions and is associated positively with cell proliferation status. We provide evidence that the association may be indirect and linked to a related parameter such as local cell density. Rolf B1.T cells arose from a population of less well-differentiated cells after a spontaneous immortalisation event. The cells retain many characteristics of normal cells, are dependent on serum growth factors for their proliferation, and fail to grow in semi-solid agar. Rolf B1.T cells support the regrowth of neurites from adult retinal ganglion cells in vitro in a heterologous co-culture system and will have potential value in investigations into the mechanisms of glial support for axonal regeneration from adult mammalian central neurons. © 1996 Wiley-Liss, Inc.     

Anorexia nervosa and tuberculosis: Case reports and a review of immune mechanisms

A pair of identical twins living together and with a long-standing history of anorexia nervosa were admitted to restore weight. In the course of their admission one of them was found to be suffering from pulmonary tuberculosis and the other developed tuberculosis after 1 year. We seek to highlight factors that can lead to a delay in case detection and discuss issues relating to the immune mechanisms in tuberculosis and anorexia nervosa. © 1994 by John Wiley & Sons, Inc.