International Comparisons of Economic Burden of EndStage Renal Disease to the National Healthcare Systems

@#The global prevalence of chronic kidney disease (CKD) is between 11 to 13%. Renal replacement therapies (RRT) – which include dialysis and renal transplantation – consume a significant portion of a country’s health resources even though only 0.1% of all CKD patients are at stage 5, also known as end-stage renal disease (ESRD). The aim of this review was to compare the magnitude of the economic burden of ESRD on national healthcare systems of selected countries with high prevalence of ESRD including Malaysia. The quantity of interest in this review were total ESRD expenditures and its proportions to the national health systems' expenditure. It was identified that total ESRD expenditure contributes between 0.91% to 7.1% of national health system expenditure in countries selected for this review. In Malaysia, the public sector - through its various agencies at the federal and state levels, accounted for almost 70% of dialysis funding; the remaining 30% came from the private sector and out-of-pocket payments. The ESRD expenditures in Malaysia constitutes 4.2% of total health expenditure by the public sector, relatively high compared to other countries. This review will summarise findings of the currently available economic evaluations of RRT in Malaysia. Based on available evidence, estimated weighted cost of treating ESRD patient in Malaysia is MYR39,346 per patient per year (USD26,648, PPP 2016).

The Passage Effect on the Senescence Profile of Cryopreserved Bone Marrow and Adipose-Derived Mesenchymal Stem Cells

Background: Although bone marrow serves as the ‘gold standard’ MSC source, adipose tissue has become a promising alternative source. Passage and cryopreservation are two effective methods to multiply, pool, and store MSC without altering its function Aims: To investigate the passage effects on the senescence profile of cryopreserved bone marrow and adipose-derived mesenchymal stem cells (MSCs). Study Design: Analytical observational study. Place and Duration of Study: Stem Cell Medical Technology Integrated Service Unit, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia, during the period of April to September 2016. Methodology: We analyzed the viability, cell size, population doubling time (PDT), percentage of senescent cells, and colony forming unit. Samples were bone marrow and adipose MSCs at passage one, which was cryopreserved for the first and second time. Numerical data were analyzed using the Student’s T test and analysis of variance (ANOVA) test. Results: Both in once and twice cryopreservation group, PDT and senescent cell percentage of bone marrow and adipose tissue MSCs differed significantly, where the PDT senescent cell percentage values of bone marrow MSCs were higher in all passages compared to adipose tissue. Regarding 30% confluence cell size and viability, significant differences between once and twice cryopreservation group varied and did not show any trend. The cell size and viability were less 2500 µm2, and more than 85%, respectively. Therefore, the difference in cell size at 30% confluence and viability might be regarded as normal variations. Conclusion: Cryopreserved adipose-derived MSCs showed better results compared to cryopreserved bone marrow-derived MSCs in terms of population doubling time (PDT) and senescence.

Comparison of fracture site callus with iliac crest bone marrow as the source of plastic-adherent cells.

Background: Red marrow has been described as the main source of mesenchymal stem cells although its aspiration and isolation from bone marrow was reported to have significant donor site morbidity. Since secondary bone healing occurs through formation of callus as the result of proliferation and differentiation of mesenchymal stem cells, callus may become alternative source for mesenchymal stem cells. In this study, we compared the number of plastic-adherent cells from fracture site callus and bone marrow of iliac crest after two and four weeks of culture. Methods: Sixteen New Zealand rabbits were fracturized at the femoral shaft. Then, these rabbits were taken care. After two weeks of fracturization, 3 mL iliac crest bone marrow aspiration and callus extraction of eight rabbits were cultured (group I). The other eight rabbits were treated equally after four weeks of fracturization (group II). Simultaneously, the cultures were observed after one and two weeks. Four weeks later, they were harvested. Cells were counted using Neubauer hemocytometer. The average number of cells between the sources and groups were statistically analyzed using the unpaired t-test. Results: In group I, there were 2.6 ± 0.1 x 104 cells in the culture of iliac crest bone marrow aspirate and 2.5 ± 0.1 x 104 cells in culture of callus extract from fracture site (p = 0.34). In group II, there were 2.7 ± 0.1 x 104 cells and 2.1 ± 0.1 x 104 cells, respectively (p < 0.001). Conclusion: Fracture site callus at the second week post-fracturization may be potential as source of plastic-adherent cells compared with iliac crest bone marrow.

Can mesenchymal stem cell survive in hydroxyapatite sulphate.

Background: Many studies have reported the role of Mesenchymal Stem Cells (MSC) in treating fractures. In case with bone defect, fracture healing needs not only osteogenic but also osteoconductive component (scaffold). Hydroxyapatite calcium sulphate (HA-CaSO4) being widely used as bone void filler, may serve as scaffold for MSC. However, the effect of this scaffold to the viability of MSC has not been evaluated before. Methods: MSC were isolated from the iliac marrow of a Giant Flamish rabbit, and expanded in DMEM using histogradient density. After one week, they were sub-cultured in a 25cc TC flask (passage 1) and have the medium replaced every 3 days. During the subculture, we embedded a HA-CaSO4 pellet into the flask. The cells were evaluated under inverted microscope at a weekly interval. Results: At the first week, MSC are difficult to be identified in microscope due to the large number of HA-CaSO4 crystals. By the third week however MSC have grown and the HA-CaSO4 crystals can readily be washed off by medium replacement. By the fourth weeks, MSC can be still seen on microscope. Conclusion: HA-CaSO4 could serve as a good scaffold due to its pellet shape and easily absorbed, thus providing revascularization which is essential for bone healing.In addition, HA-CaSO4 does not interfere with MSC survival.

Iliac crest and femoral bone marrow as the source of plastic-adherent cells.

Background: Many studies have used iliac crest as the source of mesenchymal stem cells. In cases of long bone shaft fracture, obtaining marrow from the fracture site offers more advantages. Nevertheless, due to the high number of fat cells in long bones, the yellow marrow of long bones is believed to contain lower number of mesenchymal stem cells than red marrow. Therefore the aim of this study is to compare the potency between red and yellow marrow as the donor site for the isolation of mesenchymal stem cell. Methods: Bone marrow of eight giant Flemish rabbits was aspirated from the iliac crest and femoral shaft. Mononuclear cells were isolated from both aspirates and expanded in low glucose DMEM. After eight weeks, the cells were harvested and counted using improved Neubauer hemocytometer. Comparison of the cell number between the two donor sites was then performed by t-test. Results: After 8 weeks, an average number of 2.93 ± 0.91 x 104 and 3.7 ± 2.50 x 104 cells were obtained from the iliac and femoral group respectively. No statistically significant difference was found between those two groups (p = 0.45). Conclusion: Plastic-adherent cells can be isolated and expanded from both iliac crest and femoral shaft.

Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature

Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007; 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie's disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration; and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycronr 2/0 polyester fiber). Results: After a mean follow-up period of 18 months; successful results with respect to penile straightening; normal erection; penetration and sensation; confirmed both subjectively and objectively; were achieved in all patients. Post-operative penile shortening of less than 1.5 cm was present in 50of the cases; but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100(35/43 very satisfied and 8/43 satisfied). Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful appropriate expectations; and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle; which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea; which may prevent postoperative erectile dysfunction; is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity

Status of ANC-Linked HIV Counseling and Testing as an Intervention for PMTCT in Public Health Facilities in Addis Ababa: Quality of HIV Counseling Given to Pregnant Women for PMTCT

Background: A high quality of PMTCT is essential for success: done well; it will result in significant reduction in child mortality through decreased peri-natal and postnatal HIV transmission; done badly; it could lead to deaths; increased drug resistance; and poor infant feeding. Objective: the aim of this study was to assess the quality of antenatal-based HIV counseling and testing as an intervention for PMTCT at ten public Health Centers in Addis Ababa City. Methodology: a cross sectional study was conducted at purposively selected 10 health centers in Addis Ababa from April to May 2008. Methods included observations of counseling sessions; and interview of key informants at PMTCT sites. Data on counselors' communication skills; duration and content of pre- and post test counseling was collected using a structured questionnaire adapted from UNAIDS tools. SPSS Version 15.0 was used to enter; clean; and analyze the data. Results: A total of 66 (31 pre- and 35 post test) counselling sessions were observed. The mean duration of pre-test counselling was 5.37 minutes (+3.34) and that of post test was 3.0 minutes (+ 2.24). In 78.8of the sessions; the counsellors gave clear and simple information to mothers; in 25.8of the sessions; the mothers were not given the chance to freely consent or dissent for blood test. In the post test sessions; 42.9of the mothers' understanding of the meaning of their test results was not explored. Conclusions: The communication skill of the counselors was generally 'satisfactory'. The majority of pre- and post test sessions included the basic information on HIV and PMTCT/MTCT. However; the discussions were unusually brief; rudimentary and lacked depth and coverage

Analysis of a Temporal Cluster of Shigella Boydii Isolates in Mpumalanga; South Africa; November to December 2007

Background: Shigellosis is a global human health problem. The disease is most prevalent in developing countries with poor access to safe potable water and sanitation. Shigella boydii is of particular epidemiological importance in developing nations such as African and Asian countries. In the present study; we report on the analysis of a temporal cluster of 29 S. boydii serotype 2 strains; isolated in the Mpumalanga Province of South Africa (SA) over the period of November to December 2007. Methodology: Bacteria were identified as S. boydii using standard microbiological identification techniques and serotyped using commercially available antisera. Susceptibility testing to antimicrobial agents was determined by the Etest. Genotypic relatedness of strains was investigated by pulsed-field gel electrophoresis (PFGE) analysis of digested genomic DNA. Results: The cluster of 29 isolates revealed comparable antimicrobial susceptibility profiles; while dendrogram analysis of PFGE patterns showed that the cluster of isolates grouped together and could clearly be differentiated from a random selection of unrelated S. boydii serotype 2 strains. Our data has strongly suggested that this cluster of isolates may share a common ancestry. However; this cannot be substantiated by epidemiological data because a detailed epidemiological investigation was not conducted. Conclusions: We have documented the first cluster of S. boydii infection in SA. Due to the lack of adequate epidemiological investigation; we cannot emphatically state that an outbreak had occurred. However; we do hypothesis that this was an outbreak for which a waterborne source cannot be excluded. This study has highlighted the urgent need for timely and appropriate systems of epidemiological investigation of all suspected outbreaks of disease in developing countries

Effects of non steroidal antiinflammatory drugs on the glycemic satae and inflammatory marker in poorly controlled type ii dm patients

Recent studies have shown that inflammatory markers like C-reactive protein [CRP] predicts future risk of diabetes mellitus [DM], and the data about the relationship between inflammation and the role of cyclooxygenase [COX] enzyme with type 2 DM are scar. In the present study, the clinical use of COX-inhibitors to improve glycemic state in type 2, poorly controlled DM patients was tested. Thirty eight [38] type 2 diabetic patients [12 males and 26 females] with age range of 55 +/- S.E.1.25yrs., who are maintained on hypoglycemic agents for 6.5 +/- S.E.0.92 years, but with poor glycemic control, were included in the study and randomly allocated into 3 groups; first group was treated with 25mg/day rofecoxib and the second was treated with 100 mg/day diclofenac for 2 months. The third group served as control for comparison. Fasting serum glucose [FSG], glycated hemoglobin [HbAlc], CRP and body mass index [BMI] were evaluated pre- and post-treatment. All the poorly controlled type 2DM patients included in the study were presented with high CRP levels. Treatment with rofecoxib and diclofenac for 60 days, showed relatively non-significant decrease in CRP, and did not produce any significant improvement in glycemic control. It could be concluded that COX pathway may not be the major contributor to the inflammatory events associated with DM and its associated complications. Further extensive pharmacologically based evaluation in this respect was necessary

Reference ranges of lymphocyte subsets of healthy adults in Turkey

The aim of this study was to determine the reference ranges of lymphocyte subsets in serologically HIV-negative healthy adults in Turkey. Materials and Blood samples from 220 healthy adults, 105 female and 115 male, collected into tubes containing EDTA were investigated for lymphocyte subsets using flow cytometry. The age range was 18-80 years [44.80 +/- 16.69]. The mean percentage and absolute values of the lymphocyte subsets were as follows: CD3: 72.70 +/- 8.44%, 1,680 +/- 528 cells/micro l; CD4: 47.37 +/- 9.10%, 1,095 +/- 391 cells/micro l; CD8: 28.99 +/- 5.99%, 669 +/- 239 cells/micro l; CD19: 10.96 +/- 4.44%, 254 +/- 122 cells/micro l and CD56: 7.03 +/- 3.26%, 161 +/- 92 cells/micro l, respectively. The ratio of CD4/CD8 was 1.68 +/- 0.43. There was no statistically significant difference in the percentages and absolute values of lymphocyte subsets between the genders [p > 0.05]. Immunophenotyping has been used to establish reference values of lymphocyte subsets in normal healthy adults in Turkey

Alveolar hydatid disease of the spine causing paraplegia

Hydatid disease involving the vertebral body and paravertebral soft tissues is a rare disease with poor prognosis. We report a case of spinal cord compression caused by secondary extradural cysts

Investigation of the antibiotic susceptibility patterns of pathogens causing nosocomial infections

The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years. This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria [390 Gram-negative, 180 Gram-positive] against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase [ESBL] production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips. Meropenem was the most effective antibiotic against Gram-negative organisms [89.0%]; this was followed by imipenem [87.2%] and piperacillin/tazobactam [66.4%]. The most active antibiotic against Gram-positive bacteria was imipenem [87.2%] and this was followed by piperacillin/tazobactam [81.7%] and meropenem [77.8%]. The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year [21.7%, 22.1% and 45.5%]. All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates. As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance

Inborn errors of metabolic diseases in Malaysia: a preliminary report of maple syrup urine diseases for 1993.

The Malaysian level of health care has greatly improved so that many of the infectious diseases are now under control. However, perinatal death or death due to unknown childhood diseases remains high (10.3%) being second on the list of causes of death amongst Malaysians. Could inborn metabolic diseases be the main cause of death among these children? Recently, with our success in the development of confirmatory techniques for amino acid disorders using high performance liquid chromatography (HPLC), we have examined 404 samples received from all over the country in 1993. Each specimen with abnormal findings from screening tests by one-dimensional thin layer chromatography was confirmed using HPLC. 41% had generalized aminoacidurias and 4.2% had maple syrup urine disease (MSUD). Patients were aged between 11 days to 6 years. Most of them were Malay males and presented with a history suggestive of MSUD. With this preliminary finding, further studies will be carried out in order to have an investigation and management protocol for the diseases and more importantly to formulate a strategy of screening for the country.

Boytchev procedure for recurrent anterior dislocation of the shoulder

In the Boytchev procedure, the three muscles attached to the coracoid process are re-routed deep to the subscapularis muscle. This operation was utilized in 20 patients who were followed-up for an average post-operative period of two and a half years. The dislocation did not recur in any of the cases. All cases were graded excellent or good both objectively and subjectively, except for two patients who were considered fair on subjective assessment

Triscaphe arthrodesis in the treatment of Kienbock's disease

Twelve patients with stage III Kienbock's disease were treated by triscaphe arthrodesis. The results were good concerning pain and average concerning grip strength which was ameliorated by a mean of 32%. On the contrary, limitation of joint motion was a constant postoperative findings. Radiologically, the carpal height was maintained and there were neither non-unions nor infections. Triscaphe arthrodesis seems to be a certain solution for the treatment of stage III Kienbock's disease