Economic burden of acute myeloid leukemia on patients in a resource-limited tertiary hospital in the Philippines

ABSTRACT Introduction: The remission induction treatment for acute myeloid leukemia (AML) has remained unchanged in the resource-limited setting in the Philippines. AML treatment consists of induction chemotherapy followed by high dose consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. In the Philippines, the Filipino household bears the burden of health care cost of hospitalization expenditure. Insights into the treatment costs becomes an essential requirement as these guides the allocation of resources to scheme health programs. Method: This study involved a retrospective cohort analysis of AML patients who underwent treatment for AML. Review of the statements of account per admission per patient during treatment for remission induction, consolidation, relapsed and refractory disease and best supportive care from 2017 to 2019. Of the 251 eligible patients, 190 patients were included. Result: The mean healthcare expenditure for remission induction chemotherapy (Phase 1) was US $2, 504.78 (Php 125,239.29). While 3 to 4 cycles of consolidation chemotherapy cost an average of US $3,222.72 (Php 162,103.20). For patients who had relapsed and refractory disease, an additional mean cost of US $3,163.32 (Php 159,115.28) and US $2, 914.72 (Php 146,610.55) were incurred, respectively. The average cost of palliative care was US $1,687.00 (Php 84,856.59). Conclusion: The cost of chemotherapy and other therapeutics bear most of the weight of the direct healthcare cost. The cost of AML treatment represents a significant economic burden for patients and the institution. The cost increases as patients proceed through subsequent lines of treatment for induction failure. Existing subsidy for health insurance benefits could still be improved for appropriate source allocation of resources.

The hematologic profile of Filipino HIV-infected individuals and its association with CD4 counts

ABSTRACT Introduction: Hematologic abnormalities are common in HIV and involve all blood cell lineages. A study on cytopenias, as correlated with disease progression, can be valuable in resource-limited settings. This study aimed to determine the hematologic profile of HIV patients and its association with CD4 count and antiretroviral (ARV) treatment. Methods: This is a retrospective cohort study involving adult Filipino HIV patients with complete blood count (CBC) and CD4 count determinations prior to the initiation of ARV treatment and after ≥6 months of ARV treatment. Logistic regression was performed to determine the association between cytopenias and a CD4 count <200 cells/μL. Results: The study included 302 patients. Anemia was the most common cytopenia. Anemia and leukopenia were associated with an increased likelihood of having a CD4 count <200 cells/μL in ARV-naïve patients. In ARV-treated patients, leukopenia was associated with an increased probability of having a CD4 count <200 cells/μL. An increase in hemoglobin, white blood cell (WBC) and platelet counts was observed after ≥6 months of ARV treatment. Conclusion: Anemia and leukopenia can be used as markers of immune status in HIV-infected individuals and improvement in the CBC parameters can be used to assess response to ARV treatment. Routine monitoring of hematologic parameters is recommended.

Mobility impairment and life satisfaction in the Northern Region of Malawi

There exist many psychosocial sequelae associated with mobility impairment, especially in low-resource settings where access to mobility assistive devices is limited. Objectives: This study aims to (1) define the burden and presenting aetiologies of mobility impairment in the rural Northern Region of Malawi and (2) assess the relationship between physical disability, life satisfaction and access to mobility aids. Methods: At mobility device donation clinics throughout the Northern Region of Malawi, adults living with mobility impairment were surveyed with a demographic questionnaire and a series of validated surveys to assess their physical activity levels (Global Physical Activity Questionnaire [GPAQ]), degree of mobility impairment (Washington Group Extended Set Questions on Disability) and life satisfaction (patient-reported outcomes measurement information systems satisfaction with participation in social roles and general life satisfaction). Results: There were 251 participants who qualified for inclusion, of which 193 completed all surveys. Higher physical activity scores were positively correlated with increased life satisfaction: (1) satisfaction with participation in social roles (0.481, p < 0.0001) and (2) general life satisfaction (0.230, p < 0.001). Respondents who had previously used a formal mobility device reported 235.5% higher physical activity levels ([139.0%, 333.0%], p = 0.006), significantly higher satisfaction with participation in social roles ([0.21, 6.67], p = 0.037) and equivocally higher general life satisfaction ([−1.77, 3.84], p = 0.470). Conclusion: Disability and mental health do not exist in isolation from one another. Given the positive correlations between formal mobility device usage and both physical activity and life satisfaction, interventions that increase access to mobility-assistive devices in undertreated populations are imperative. Contribution: This study contributes to the understanding of the complex relationship between physical disability, access to mobility aids, and life satisfaction. Results from this study suggest the potential benefit that increasing access to mobility aids may have in improving the quality of life of mobility impaired persons in resource-limited settings, such as the Northern Region of Malawi

Frequency and carbapenems susceptibility profile of non-fermenting Gram-negative bacilli isolated from clinical samples between 2007 and 2012 / Frequência e perfil de suscetibilidade aos carbapenêmicos de bastonetes Gram-negativos não fermentadores de glicose isolados de amostras clínicas entre 2007 e 2012

ABSTRACT Introduction: One of the major problems in health services is the occurrence of healthcare-associated infections (HAIs) by microorganisms resistant to various antimicrobials. Objectives: To describe the frequency and susceptibility profile of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems in the hospital from Fundação Santa Casa de Franca, São Paulo, Brazil. Methods: The susceptibility of P. aeruginosa and A. baumannii to carbapenems from 304 clinical isolates between 2007 and 2012 was retrospectively analyzed from a microbiology database at the clinical laboratory of the hospital of Fundação Santa Casa de Franca, São Paulo, Brazil. Results: From isolated and identified strains, 236 (5.3%) P. aeruginosa were susceptible to imipenem (2007 - 69.6% to 2012 - 41.7%) and meropenem (2007 - 63.3% to 2012 - 25%). In addition, all 68 (1.7%) A. baumannii isolates were susceptible to both antibiotics. Conclusion: A. baumannii resistance to carbapenems was not identified; however, there was a decrease in susceptibility to carbapenems over the years for P. aeruginosa.

RESUMO Introdução: Um dos grandes problemas nos serviços de saúde é a ocorrência de infecções relacionadas com assistência à saúde (IRAS) por microrganismos resistentes a vários antimicrobianos. Objetivos: Descrever a frequência e o perfil de suscetibilidade de Pseudomonas aeruginosa e Acinetobacter baumannii aos carbapenêmicos no hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Métodos: Retrospectivamente, a suscetibilidade de P. aeruginosa e A. baumannii aos carbapenêmicos foi analisada em 304 isolados clínicos entre 2007 e 2012, a partir de um banco de dados do setor de microbiologia do laboratório clínico do hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Resultados: Das cepas isoladas e identificadas, 236 (5,3%) P. aeruginosa eram suscetíveis a imipenem (2007 - 69,6% a 2012 - 41,7%) e meropenem (2007 - 63,3% a 2012 - 25%). Além disso, todos os 68 (1,7%) isolados de A. baumannii eram suscetíveis aos dois antibióticos. Conclusão: Não foi identificada resistência de A. baumannii aos carbapenêmicos, no entanto houve diminuição da suscetibilidade aos carbapenêmicos no decorrer dos anos para P. aeruginosa.

Evaluation of a protocol for reducing the microbial contamination of dental unit water

Biofilm on dental unit waterlines can spread microbial contamination in the water. The aim of this study was to investigate microbial contamination of water from supplies and dental units before and after the implementation of a protocol for microbial quality improvement and maintenance of dental unit water. The microbial load was evaluated in water from 27 taps and dental units (reservoirs, airwater syringes and highspeed outputs without handpieces) using the Petrifilm™ system (total aerobic bacteria and fungi) and conventional culture media (enterobacteria and Legionella spp.). The bacterial load in water samples from taps and reservoirs was within the parameter established by Brazilian legislation (<500CFU/mL); but the bacterial load in samples from airwater syringes and highspeed outputs without handpieces was not. The imple mentation of the protocol for the maintenance of microbial quality in dental unit water reduced bacterial load in highspeed outputs without handpieces (p=0.004). Enterobacteria and Legionella spp. were not isolated from any of the water samples from taps and dental units (AU)

Biofilme nas linhas d'água de equipos odontológicos pode propagar contaminação microbiana na água. O objetivo deste estudo foi investigar a contaminação microbiana da água de abastecimentos e equipos odontológicos antes e após a implemen tação de um protocolo para melhoria e manutenção da qualidade microbiológica da água de equipos odontológicos. Avaliouse a carga microbiana da água de 27 torneiras e equipos (reservatórios, seringas tríplice e alta rotação sem as peças de mão) de uma clínica odontológica por meio do sistema Petrifilm™ (bactérias aeróbias totais e fungos) e meios de cultura convencionais (enterobactérias e Legionella spp.). A carga bacteriana em amostras de água das torneiras e reservatórios estava dentro do parâmetro estabelecido pela legislação brasileira (<500 UFC/mL), mas a carga bacte riana das seringas tríplices e das saídas dos alta rotação sem as peças de mão não estava. A implementação do protocolo para manutenção da qualidade da água dos equipos reduziu a carga bacteriana nas saídas dos alta rotação sem as peças de mão (p=0,004). Enterobactérias e Legionella spp. não foram isoladas de qualquer das amostras de água das torneiras e dos equipos odontológicos (AU)

Acute care in Tanzania: epidemiology of acute care in a small community medical centre

Introduction :Without uniform recognition of Emergency Medicine as a specialty in developing sub-Saharan African countries; data are limited on the epidemiology of emergency care needs. The purposes of this study were to quantify the burden of disease presenting as medical or surgical emergencies and describe the patient population at a small community medical centre in the Republic of Tanzania. Methods : An observational study was conducted from March to June 2011 at the University of Arusha (UOA) Medical Centre in Arusha; Tanzania. All consenting patients presenting with acute illness or injury were eligible for inclusion in the study. A standardized form was used to record demographic information; chief complaint; diagnosis/diagnoses; procedure(s); treatment(s); and disposition. Results : Data were collected on 719 patients; with a mean age of 21.8 years (range neonate to 83 years). Fever (19.5); respiratory (17.5); and gastrointestinal complaints (15.0) were the top three chief complaints; 94.9 of chief complaints were atraumatic. The top three diagnoses included respiratory infection (22.1); malaria (21.4); and skin or soft tissue infection (7.9). Forty-three percent of patients required no procedures or tests; and 42 required only one procedure or test. Of treatments administered; 67.6 were analgesics; 51.3 were cough medications; and 47.6 were antipyretics. Ninety-seven percent of patients were discharged home after their visits. Discussion: Respiratory infections; malaria; and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha; Tanzania; highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma; burns; and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis; most treatments administered were inexpensive; and most patients were discharged home; suggesting that providing acute care in this setting could be accomplished with limited resources

Three level risk assessment for pancreatic fistula formation after distal pancreatectomy with a strategy for prevention.

Background: Distal pancreatectomy (DP) has a high post-operative morbidity predominantly due to pancreatic fistula though the mortality is very low. Data on distal pancreatectomy was reviewed to analyse the risk factors that contribute to this morbidity. Methods: Thirty three patients underwent distal pancreatectomy with sutured closure of the remnant, over a 5-year period between May 2006 and April 2011. Pancreatic fistula (PF) was defined according to the International Study Group on Pancreatic Fistula definition. Patient and surgical risk factors were subdivided as those reflecting a poorer pre-morbid status, those associated with increased complexity of surgery and those related to pancreas gland and were analyzed for incidence of pancreatic fistula. Results: Indications for DP included 16 (51.5%) pancreatic tumours, 13 (39.4%) chronic pancreatitis and 3 (9.1%) trauma. Spleen was preserved in 12 patients (36.4 %).There was no mortality while the morbidity rate was 45.5% (n=15). Incidence of pancreatic fistula was 30.3% (n=10); eight were grade A (80%) and two were grade C (20%). Incidence of clinically significant pancreatic fistulae was 6.1%. PF was significantly more common if the pancreatic duct was not identified (p=0.024) was significantly less with extensive peri-pancreatic adhesions (p=0.036). Conclusions: Identification and ligation of main pancreatic duct can help reduce the incidence of pancreatic fistulae. The identification of patients at high risk of developing a PF helps to implement prevention strategies.

The toxicity evaluation of Syzygium cumini leaves in rodents

This study aimed to evaluate the safety of the hydroalcoholic extract (HE) of Syzygium cumini (L.) Skeels, Myrtaceae, leaves in rodents. Acute toxicity was evaluated through the determination of a LD50 in mice and rats (up to 14 days). In mice, the oral administration (p.o.) of the HE (0.1 at 6 g/kg) did not cause any death. When administered by intraperitoneal route (i.p.) the HE (0.1 at 1 g/kg) caused death of the animals (LD50 of 0.489 g/kg). In rats, the HE (0.5, 1 and 2 g/kg, p.o.) did not cause any death, while by i.p., only the 2 g/kg dose was lethal to 67 percent of the animals. To evaluate chronic toxicity, groups of rats daily received the HE (0.05, 0.1 and 0.25 g/kg) through p.o., during 30, 90 or 180 days and the effects on behavior, body weight, feed consumed were measured. Histology, hematology and biochemical parameters were measured at the end of the treatment. After a 30-day treatment, the HE caused changes in some biochemical parameters. Histological examination of the liver, kidneys, lungs, heart, stomach, intestine and pancreas showed normal architecture suggesting no morphological disturbances. These data may mean that the HE of S. cumini does not exert acute or chronic toxic effects by oral administration.

Antispasmodic effect of Jatropha gossypiifolia is mediated through dual blockade of muscarinic receptors and Ca2+ channels

The antispasmodic activity of Jatropha gossypiifolia L., Euphorbiaceae, aerial parts was investigated in rodents using the mouse intestinal transit model and acetylcholine (ACh, 10-9 to 10-4 M) and calcium (CaCl2, 10-4 to 10-1 M)-induced contractions of isolated rat jejunum. Similar to atropine (1 mg/kg), oral doses of ethanolic extract (EE) of J. gossypiifolia (500, 1000 and 2000 mg/kg) produced a decrease in intestinal transit (37.6 to 57.1 percent) when compared with control. The ACh-induced contraction in the jejunum was inhibited by EE (0.5, 1.0 and 2.0 mg/mL), chloroformic (CF) and aqueous fractions (0.1 and 0.5 mg/mL) and methanolic subfraction (0.05 and 0.25 mg/mL), suggesting an antimuscarinic mechanism. CaCl2 - induced responses in jejunum were also attenuated in the presence of CF (0.05 and 0.1 mg/mL) implying a direct interference of CF with the influx of calcium ions in the cells. Only the organic fraction of the extract had a calcium-antagonist effect, whereas both chloroformic and aqueous fractions had anticholinergic effect. These results suggest that the antispasmodic effect of J. gossypiifolia may be due a combination of anticholinergic and calcium antagonist mechanisms.

Percepção dos alunos de graduação em enfermagem sobre ser enfermeiro / The perception of being a nurse by nursing students

O objetivo desse estudo foi identificar o perfil dos alunos e da profissão enfermeiro por estudantes do primeiro ano do curso de graduação em enfermagem. Os dados obtidos através de uma redação demostraram que os alunos vieram para universidade com uma visão de que ser enfermeiro é saber gerenciar os serviços de enfermagem, com capacidade para cuidar/ajudar, manter e promover a saúde da população; os motivos que levaram o estudante a optar por esta profissão foram por gostar da mesma e por aumentar o conhecimento técnico e científico; entre os aspectos positivos estão os vários campos de atuação da enfermagem, poder colaborar com a cura e entre os aspectos negativos estão os baixos salários e lidar com a morte.