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Background@#The objective of this study was to compare the performance of cystatin C- and creatinine-based estimated glomerular filtration rate (eGFR) equations in predicting the clearance of vancomycin. @*Methods@#MEDLINE and Embase databases were searched from inception up to September 2019 to identify all studies that compared the predictive performance of cystatin C- and/or creatinine-based eGFR in predicting the clearance of vancomycin. The prediction errors (PEs) (the value of eGFR equations minus vancomycin clearance) were quantified for each equation and were pooled using a random-effects model. The root mean squared errors were also quantified to provide a metric for imprecision. @*Results@#This meta-analysis included evaluations of seven different cystatin C- and creatinine-based eGFR equations in total from 26 studies and 1,234 patients. The mean PE (MPE) for cystatin C-based eGFR was 4.378 mL min −1 (95% confidence interval [CI], −29.425, 38.181), while the creatinine-based eGFR provided an MPE of 27.617 mL min −1 (95% CI, 8.675, 46.560) in predicting clearance of vancomycin. This indicates the presence of unbiased results in vancomycin clearance prediction by the cystatin C-based eGFR equations.Meanwhile, creatinine-based eGFR equations demonstrated a statistically significant positive bias in vancomycin clearance prediction. @*Conclusion@#Cystatin C-based eGFR equations are better than creatinine-based eGFR equations in predicting the clearance of vancomycin. This suggests that utilising cystatin C-based eGFR equations could result in better accuracy and precision to predict vancomycin pharmacokinetic parameters.
ABSTRACT
@#In Malaysia, dialysis-treated end stage renal disease (ESRD) patients have been increasing rapidly. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) use a disproportionately large amount of limited healthcare resources. This study aims to estimate the costs of HD and CAPD from the Ministry of Health (MOH) perspective. One year prospective multicentre study was conducted from October 2016 to September 2017 to assess direct medical costs of 90 HD patients and 73 CAPD patients from five large MOH dialysis centres. A mixed method of activity-based costing and step-down was used. The capital costs included land, building, medical equipment and furnishing. The recurrent costs included staff emoluments, facility utilities, patients’ medical costs and dialysis consumables. One-way sensitivity analysis was performed to investigate variability in the data. One hundred and forty-one patients (82%) completed the study comprising of 77 patients on HD and 64 patients on CAPD. Majority of the patients were between 46-65 years old (n=75, 53.2%). The most common aetiology of ESRD was diabetes mellitus (44.2% in HD and 48.4% in CAPD). Cost per patient per year was RM39,790 for HD and RM37,576 for CAPD. The main cost drivers were staff emoluments (37.6%) and dialysis consumables (70.5%) for HD and CAPD respectively. HD is highly sensitive towards all the variables analysed except for dialysis consumables. In CAPD, there are minimal sensitivities except for the 5% discount rate. Knowledge of the costs of modalities are useful in the context of planning for dialysis services and to optimise the number of kidney failure patients treated by dialysis within the MOH.
Subject(s)
Peritoneal Dialysis, Continuous Ambulatory , Kidney Failure, Chronic , Costs and Cost Analysis , MalaysiaABSTRACT
Amputation is usually the last resort for treatment of non-salvageable limbs due to various indications such as trauma, infection and malignancy. However, some patients still refuse surgery and reconstruction. Instead, they insist on keeping their limbs despite knowing the negative consequences including a limited or non-functioning limb. We present three cases who refused amputations: The first was a nine-year-old boy involved in a motor vehicle accident [MVA], with a left femoral midshaft open grade IIIb fracture; the mangled extremity severity score [MESS] was five. The second was a 16-year-old girl sustained a left leg crush injury, a fractured left fibula and an injury to the anterior tibial artery following an MVA; her MESS was 12. The third was a 60-year-old left-handed tractor driver presented with a fiveyear history of a slowly enlarging fungating growth over the dorsum of his left hand; biopsy confirmed basal cell carcinoma [BCC]. We explore the cultural and religious reasons behind this stigma of amputation in a multiethnic community. It will help clinicians to manage these challenging situations according to the principles of medical ethics
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Sturge-weber syndrome is a disease characterized by capillary or cavernous haemangionsm (Port-wine stain) along the cutaneous division of Trigennial nerve. There is venous haemangionsm in subjacent leptomeninges, which may spread causing atrophy of cortex. The patient Md. Zobair Hossain, 11 years old boy, nondiabetic, nonhypertensive presented to us on 20.05.2011 with the complaints of repeated bleeding from a swelling over the outer aspect of right eye ball for 1 month, weakness of left half of body for 1 year and repeated convulsion for 7 years. Diagnosis was confirmed vy CT scan of brain. Through treatment is unsatisfactory, he was advised for laser theraphy for coetaneous lesion and anti-convulsant drug epilepsy.
ABSTRACT
The presence of end stage renal disease [ESRD] has a negative impact on patients' quality of life [QOL]. Renal transplantation is well-recognized to provide a better QOL than other modalities of renal replacement therapy. To evaluate the QOL in our renal transplant recipients and to determine the factors that influences it at our institution. Cross-sectional observational study. University Kebangsaan Hospital, Malaysia. Renal transplant recipients between 18 and 75 years who have been transplanted more than one year. QOL was assessed using the Short Form-36 questionnaire that has been validated in the Malay language. Thirty nine patients [29 male, 10 female] were enrolled. The SF-36 scores were physical functioning [47.85 +/- 6.93], role physical functioning [49.51 + 11.08], general health [51.43 +/- 6.22], vitality [60.53 +/- 6.61], social functioning [50.85 +/- 9.26], mental health [55.74 +/- 7.16], bodily pain [58.55 +/- 7.51], role emotional functioning [49.09 +/- 12.01], physical component summary [49.37 +/- 6.87] and mental component summary [55.23 +/- 6.66]. Predictors of QOL were education [p < 0.001], serum albumin [p = 0.017] and hemoglobin [p = 0.02]. Increasing age negatively impacted physical functioning [p = 0.029]. We also found those who received a commercial transplant had a lower mental health compared to those done locally [p = 0.031]. Predictors of QOL in our renal transplant cohort were age, education, serum albumin and hemoglobin
Subject(s)
Humans , Male , Female , Quality of Life , Kidney Failure, Chronic/psychology , Outcome Assessment, Health Care , Cross-Sectional Studies , Biomarkers , Surveys and Questionnaires , Data CollectionABSTRACT
The present study was carried out to determine the antinociceptive, anti-inflammatory and antipyretic activities of the aqueous extract of Bauhinia purpurea leaves using animal models. The air-dried, powdered leaves [approx; 20 g] were soaked in distilled water [1:20; w/v] at room temperature for 72 h and the supernatant obtained was freeze-dried. The crude dried extract [approx; 2.4 g] was prepared in doses of 6.0, 30.0 and 60.0 mg/kg, and subjected to the respective antinociceptive [abdominal constriction, hot plate and formalin tests], anti-inflammatory [carrageenan-induced paw edema test] and antipyretic [brewer's yeast-induced pyrexia test] assays. The results obtained indicate that the extract possessed significant [p < 0.05] antinociceptive, anti-inflammatory and antipyretic activities, which were not dependent on the doses of extract used. The highest concentration of extract was less effective as an anti-inflammatory and an antipyretic agent. This study showed that the aqueous extract of B. purpurea leaves possesses potential pharmacological activities that require further investigation and, thus, confirms the folklore use of the plant in the treatment of ailments associated with pain and inflammation