The opinion of general practitioners in Malaysia on newly imposed third party health administrator policies in primary care.

BACKGROUND: Third Party Health Administrators (TPA) has become an integral part in the field of funding healthcare for most parts in the world. Although they ensure access to medical care when out-of-pocket payment is required, TPAs have been found to impose unreasonable dictation in medicine prescriptions that undercuts doctors remuneration including paying very low medical consultation fees, types/methods of treatment and modalities for their policy holders. The objective of this study was to get the opinion of Malaysian doctors regarding the newly imposed policies and rates that these companies have forcibly dictated towards private primary care General Practitioners (GPs). MATERIALS AND METHODS: This was a cross sectional study, conveniently sampling private GPs currently practicing in Malaysia. A self-developed online questionnaire was sent out to the members via social media with the assistance of the Malaysian Medical Association the affiliates of Federation of Private Medical Practitioners Associations of Malaysia and Medical Practitioners Coalition Association of Malaysia. Data was collected from April to July 2021. A series of 7 short questions were asked in the survey to yield a higher response rate. A population to proportion sample size was calculated and a minimum of 365 responses were required. All data collected were collated and analysed in the SPSS v21.0 RESULTS: From a total of 7,000 GPs, 491 GPs (134.52% of intended sample size) responded to the questionnaire. The largest portion of respondents were from Selangor (21.79%). A total of 65.58% of the GPs felt that the RM 15 consultation fee dictated by the TPAs was unfair, 71.08% felt it was unfair that TPA overwrote certain investigations done or medicines given as over-treatment, 90.84% felt that TPAs had no jurisdiction to dictate the number of days of medication patients needed for chronic medical conditions, 95.52% did not agree that TPAs fix the price of each medication, 54.58% agreed that marking up medications from 5-15% of the original purchase price was fair and 68.64% agreed that they would boycott TPAs that were unreasonable with their dictation/demands. CONCLUSION: GPs generally disagreed with many new policies imposed by TPAs. These new policies might hinder the screening, management and early detection of chronic non communicable diseases here in Malaysia.

Tropism of engineered and evolved recombinant AAV serotypes in the rd1 mouse and ex vivo primate retina.

There is much debate on the adeno-associated virus (AAV) serotype that best targets specific retinal cell types and the route of surgical delivery-intravitreal or subretinal. This study compared three of the most efficacious AAV vectors known to date in a mouse model of retinal degeneration (rd1 mouse) and macaque and human retinal explants. Green fluorescent protein (GFP) driven by a ubiquitous promoter was packaged into three AAV capsids: AAV2/8(Y733F), AAV2/2(quad Y-F) and AAV2/2(7m8). Overall, AAV2/2(7m8) transduced the largest area of retina and resulted in the highest level of GFP expression, followed by AAV2/2(quad Y-F) and AAV2/8(Y733F). AAV2/2(7m8) and AAV2/2(quad Y-F) both resulted in similar patterns of transduction whether they were injected intravitreally or subretinally. AAV2/8(Y733F) transduced a significantly smaller area of retina when injected intravitreally compared with subretinally. Retinal ganglion cells, horizontal cells and retinal pigment epithelium expressed relatively high levels of GFP in the mouse retina, whereas amacrine cells expressed low levels of GFP and bipolar cells were infrequently transduced. Cone cells were the most frequently transduced cell type in macaque retina explants, whereas Müller cells were the predominant transduced cell type in human retinal explants. Of the AAV serotypes tested, AAV2/2(7m8) was the most effective at transducing a range of cell types in degenerate mouse retina and macaque and human retinal explants.

Cancer profile in the Department of Pathology of Sri Devaraj Urs Medical College, Kolar: a ten years study.

CONTEXT: Cancer profile varies in different regions and depends on race, lifestyle and diet. The study of a cancer profile helps to know the common cancers in a particular population, its probable risk factors and also helps in cancer control programs. AIM: To study the cancer profile at Kolar, based on Pathology Department records. SETTINGS AND DESIGN: Retrospective study from January 1997 to December 2006. MATERIALS AND METHODS: Cancer cases diagnosed by fine needle aspiration cytology (FNAC) and histopathology in the Department of Pathology were included in the study. The relevant history, clinical findings, and sociodemographic information of each case was retrieved from hospital records. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: Out of a total of 19,615 cases reported at the Department of Pathology, 2,744 (13.98%) were cancer cases. The peak incidence was in the fifth decade in females and the seventh decade in males. Male : Female ratio was 0.7 : 1. Overall there was a steady rise in the number of cases from year 1997 to 2006. The top ten cancers in males were of oral cavity, stomach, esophagus, bone, non-Hodgkin's lymphoma (NHL), prostate, liver, larynx, penis, and Hodgkin's disease / bladder and those in females were oral cavity, cervix, breast, stomach, esophagus, thyroid, ovary, bone, rectum, and melanoma. CONCLUSIONS: Oral cavity and upper gastrointestinal cancers predominated in both genders. In females, cervical cancer predominated over breast cancer. Thyroid cancers were relatively more common in this region especially in females.

Castration-induced hyperactivity of seminal vesicle in the catfish Clarias batrachus: a case of paradox and blockade by antiandrogen (cyproterone acetate) treatment.

Castration of the catfish Clarias batrachus in late preparatory-early prespawning phase (April-May) caused time-dependent stimulatory effect on morphology, weight, and in the concentrations of biochemical correlates, such as total proteins, fructose, hexosamines and sialic acid in the seminal vesicle (SV). The peak changes were noticed on week 4 of castration. The hyperactivity was related to augmented production of testosterone by the SV of castrates with the levels significantly high from week 3 onwards. As a result, serum testosterone level fluctuated with a significant decrease in the first and fifth weeks, a significant increase in the third week, and no significant difference in the second and fourth weeks. Serum E2 level decreased significantly throughout. Cyproterone acetate treatment (CA; 1 mg/fish daily for 21 days) from the second day of castration decreased the size and weight of the SV and the concentrations of total proteins, hexosamines, fructose and sialic acid. The antiandrogen treatment did not alter serum testosterone level but the E2 level was significantly decreased. It is concluded that the hypersecretory activity of the SV in castrates is a sequel to local synthesis and action of testosterone and the effect could be prevented by CA by blocking androgen actions.

Effects of ovine LH, GH and prolactin, and testosterone on serum testosterone and estradiol-17 beta levels, and seminal vesicle and testicular activity in the catfish Clarias batrachus (L.).

Intraperitoneal administrations of testosterone (0.5 microgram/g body wt), and ovine LH (1.0 microgram/g body wt), GH (5 micrograms/g body wt) and prolactin (10 micrograms/g body wt) daily for 7 days during early prespawning phase (May) in C. batrachus produced varied effects on seminal vesicle (SVSI) and testicular (GSI) weights and biochemical correlates. Testosterone and LH treatments significantly increased serum testosterone level and concentrations of total proteins, fructose, hexosamines and sialic acid in both seminal vesicles and testis. Serum E2 levels increased significantly only after testosterone treatment. GH treatment increased significantly serum testosterone level and only the concentrations of SV hexosamines and testicular protein. Prolactin, however, significantly lowered serum testosterone level and concentrations of total protein, hexosamines in both SV and testis, and testicular fructose and sialic acid levels. The results show that the stimulating effect of LH and GH on SV and testicular activity is mediated through the increased secretion of testosterone and the inhibitory effect of prolactin by decreased testosterone secretion.

Intense high-energy proton beams from Petawatt-laser irradiation of solids.

An intense collimated beam of high-energy protons is emitted normal to the rear surface of thin solid targets irradiated at 1 PW power and peak intensity 3x10(20) W cm(-2). Up to 48 J ( 12%) of the laser energy is transferred to 2x10(13) protons of energy >10 MeV. The energy spectrum exhibits a sharp high-energy cutoff as high as 58 MeV on the axis of the beam which decreases in energy with increasing off axis angle. Proton induced nuclear processes have been observed and used to characterize the beam.

Methallibure inhibition of testicular and seminal vesicle activity in catfish, Clarias batrachus (Linn.): a study correlating changes in serum sex steroid profiles.

The administration of methallibure (2 microg/g BW, daily for 15 days) in Clarias batrachus in prespawning phase (May-June) resulted in decreased weights of seminal vesicle (SV) and testis, and reductions in the concentrations of total proteins, fructose, hexosamines, and sialic acid in SV and testis. The inhibitory changes can be attributed to impairment of steroidogenesis, serum levels of testosterone and estradiol -17beta decreased significantly. Withdrawal of methallibure treatment for 7 and 15 days resulted in gradual recovery and restoration of all the above parameters except the sialic acid levels in the SV and testis, and fructose level in the SV. The methallibure induced regressive changes in the SV and testis were discussed in the light of its GTH inhibiting property.

Kimura's disease: a report of three cases with a brief review of literature.

Kimura's disease (KD) is an uncommon chronic inflammatory condition of unknown aetiology involving subcutaneous tissue, presenting as a tumor like lesion with a predilection for the head and neck region. Clinically it is often confused with parotid tumor with lymph node metastasis. It is difficult to diagnose before tissue biopsy. Fine needle aspiration cytology has only limited value. Unless the pathologists are aware of this entity, it might be misdiagnosed. Surgery, radiotherapy and steroid therapy have been tried but none is proved best and recurrence is common. Three cases of KD seen in our hospital and the problems encountered in them are presented.

Pituitary-gonadal Relationship in the Catfish Clarias batrachus (L): A Study Correlating Gonadotrophin-II and Sex Steroid Dynamics.

A heterologous radioimmunoassay was developed for measuring gonadotrophin-II (GTH-II) in the catfish Clarias batrachus. Serum and/or pituitary levels of GTH-II showed significant annual/seasonal variations in male and female catfish, which could be correlated with both gonadosomatic index and/or serum testosterone level. GTH-II was not detected in resting phase, increased during gonadal recrudescence to peak values in late prespawning /spawning phases, and declined to low values in postspawning phase. During gonadal recrudescence, the pituitary and serum levels of GTH-II maintained positive or inverse relationships implying differential rates of hormone release and synthesis/storage. Gonadectomy resulted in increased release of GTH-II; the release pattern varied in females and hemi-castrated or completely castrated males. In females, the GTH-II increase followed a distinct biphasic pattern with the peak rise at week 4 of ovariectomy. In males, castration resulted in significant rise of serum GTH-II levels at all duration except week 5, but the magnitude of the rise was higher in completely castrated fish (weeks 1, 2 and 3). Testosterone replacement in 3-week hemi-castrated fish restored the GTH-II level to that of the sham control vehicle group. In intact fish, administration of testosterone elicited an increase in serum GTH-II levels in the low dose (0.25 and 0.5 mug / g BW) groups and no change in the high dose (1.0 mug / g BW) group. Methallibure treatment inhibited GTH-II levels in a dose-dependent manner. The reduction was greater in males. Withdrawal of the drug treatment restored the GTH-II and testosterone levels after 15 days in the low dose group (2 mug / g BW). The results indicate that there exists a dynamic positive or negative feedback relationship between gonadal steroids and GTH-II, which is essential to control the release and availability of circulating GTH-II.

Precocious recrudescence of seminal vesicle and testis in catfish, Clarias batrachus (Linn.), subjected to a long photoperiod regime.

The catfish C. batrachus were exposed to a long photoperiod of 14 hr light during resting--early preparatory (December-February) phases of the reproductive cycle. At 70-day sampling, both the seminal vesicle (SV) and testis registered marked stimulatory effects in comparisons to control fish maintained under approximately 10.55 L:13.45D as shown by the increased size and weight. In both the SV and testis, concentrations of total proteins, fructose, hexosamines, and sialic acid were significantly high compared to those of the control fish indicating increased activities of the organs. Serum levels of gonadotropin-II, testosterone, and estradiol-17 beta were significantly high in the long photoperiod group. The results show that exposure to long photoperiod can stimulate early development of both the SV and testis by activating the pituitary--gonadal axis.

Effects of administration of testosterone on seminal vesicle activity in the catfish Clarias batrachus during preparatory phase: a study correlating changes in testis and serum sex steroid levels.

In the catfish Clarias batrachus administration of testosterone (0.25, 0.5 and 1.0 microgram/g BW for 30 days) during the preparatory phase increased significantly gonadosomatic index (GSI), seminal vesicle-somatic index (SV-SI) and concentrations of proteins, fructose, hexosamines, and sialic acid in the SV and testis in a dose-dependent manner. These stimulatory effects could be correlated positively with the increase of serum testosterone level. Serum estradiol-17 beta was also significantly high in the testosterone groups.