ABSTRACT
<p><b>INTRODUCTION</b>Cervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer.</p><p><b>METHODS</b>A lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore.</p><p><b>RESULTS</b>Introduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV.</p><p><b>CONCLUSION</b>AS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.</p>
ABSTRACT
The purpose of this report was to evaluate the role anti-VEGF in management of CNVM secondary to ocular toxoplasmosis. Young female diagnosed as a case of bilateral ocular toxoplasmosis presented with complaints of diminution of vision in the right eye. Fundus examination showed an active CNVM adjacent to toxoplasmosis scar. In view of active CNVM, patient was administered intravitreal ranibizumab. A total of 2 injections of intravitreal ranibizumab were given. Fundus showed a scarred CNVM adjacent to the toxoplasma scar with no clinical signs of activity. Anti-VEGF therapy has been successfully used to improve visual and anatomical outcome in juxtafoveal [deleted subfoveal] CNVM secondary to toxoplasmosis
ABSTRACT
Patients which have diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Cancer victims could survive longer due to settling treatment modalities, and then would likely develop a new metachronous malignancy. This article aims to report our observed trend of increasing, in prevalence of both synchronous and metachronous second primary malignancy, among the cancer victims, and to review the relevant literature. A hospital based retrospective gathering of prospective data, among the patients that have diagnosed with second de novo malignancy. The study has conducted over a 4 years period from 2009 to 2012. All patients that have diagnosed with a histologically proven second malignancy as per Warren and Gates criteria have included. Various details which have regarded site, age at presentation, sex, synchronous or metachronous, treatment have recorded. Among 41 cases of multiple primary malignancies that have observed, 8 were synchronous [19.51%] and 33 were metachronous [80.49%]. Out of 41 patients, 25 [60.98%] were females and 16 [39.02%] were males. The most common sites of primary tumor were head and neck cancers that have followed by gynecological cancers, breast cancer, lung cancer, esophageal cancer, and then the others. Among the second malignancy, the most common site was breast and gastrointestinal tract that have followed by lung and gynecological cancers. Out of the total number of cases with double location, 14 tumors [34.15%] have belonged to the breast, out of which 5 [12.20%] have represented first locations and 7 [17.07%] have been second locations. Both locations have belonged to the breast in 2 patients [4.9%]. In 5 cases [12.20%], there were associations of breast-cervix and in 6 cases [14.63%], there were association of lung-head and neck cancers. The incidence of multiple primary malignancies has not been rare at all. Screening procedures have especially been useful for the early detection of associated tumors, whereas careful monitoring of patients has treated for primary cancer, and then a good communication between patients and medical care team would certify not only an early detection for secondary tumors, but only finally and subsequently, an appropriate management
ABSTRACT
Dexamethasone Posterior-Segment Drug Delivery System is a novel, biodegradable, sustained-release drug delivery system [OZURDEX[registered sign]] for treatment of macular edema following retinal vein occlusion and posterior uveitis. However, its potential role in management of diabetic macular edema has not been reported yet. The aim was to evaluate the safety and efficacy of [OZURDEX[registered sign]] in patients with recalcitrant diabetic macular edema [DME]. A retrospective, interventional case series from a tertiary eye care center in India is presented. Inclusion criteria comprised patients presenting with recalcitrant DME, 3 or more months after one or more treatments of macular laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor [VEGF] injections. Exclusion criteria included history of corticosteroid-responsive intraocular pressure [IOP] rise, cataract extraction, or other intraocular surgery within 3 months. The main outcome measure was visual acuity at 1 and 4 months after OZURDEX[registered sign] injection. Secondary outcome measures included change in central macular thickness on Optical coherence tomography [OCT] and changes in IOP following intravitreal OZURDEX[registered sign] implant. Of 18 eyes [17 patients] with recalcitrant diabetic macular edema that underwent OZURDEX[registered sign] implant, three eyes [two patients] had follow-up of more than 3 months post-injection. Mean age of patients was 56 years. Mean duration of diabetes mellitus was 16.6 years. Systemic control of DM was good as assessed by FBS/PPBS and HbA1c. The pre-operative mean central macular thickness was 744.3 micro m and improved to 144 and 570 micro m at months 1 and 4, respectively. Preoperative mean BCVA was 0.6 logMAR units and improved to 0.3 and 0.46 logMAR units at month 1 and 4, respectively. The mean follow-up was 4.3 months [range 4-5 months]. OZURDEX[registered sign] appears efficacious in management of recalcitrant diabetic macular edema. The results of the ongoing POSURDEX[registered sign] study will elaborate these effects better